Good Life Grant – Enrollment Part 2

Step 1 of 4

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Parent/Student

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Contact Owner

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Parent/Guardian Name(Required)

First Last

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Parent/Guardian Email(Required)

Enter Email Confirm Email

Preferred Phone Number

Alternate Phone Number

Would you like to receive SMS updates on your student's progress?

Yes

Enter Mobile Number

Physical Street Address

Street Address City State / Province / Region ZIP / Postal Code Country

Is your mailing address the same as your street address?

Yes

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

Native Nation:

Tribal Enrollment #:

Which HCN District do you live in?

Would you like to add a second parent/guardian?

Yes

Additional Parent/Guardian Name

First Last

Additional Parent/Guardian

Enter Email Confirm Email

Additional Parent/Guardian Phone Number

Additional Parent/Guardian SMS

Does the Additional Parent/Guardian have a different address?

Yes

Additional Parent/Guardian Address

Street Address City State / Province / Region ZIP / Postal Code Country

Add Children/Students

Student's Name	Student Email	Student Age	Actions

There are no Students.