Blessing of Summit & Portage Counties, Inc.

Student Application

  (* indicated a required field.)

(GRADS Teacher, Family & Consumer Sciences Teacher, or Guidance Counselor, Address, Phone)
Non-Family Member (at least 21 years old), Relation, Address, Phone
Friend, Family, Teacher, Administrator, School Nurse (at least 21 years old) Title, Address, Phone

By clicking “Submit” I  agree that the information provided is accurate to the best of my knowledge.