Interest Form

Interest Form
Are you interested in our programs and/or services, but are unable to register at this time? Fill out the interest form below, and we'll send you more information!
Name*
First Middle Initial Last
Best email to reach you with more information:*
Enter Email Confirm Email
Best phone number to reach you with more information:*
Address
Street Address Address Line 2 City State ZIP Code
Prospect Type*
- Parent/Supportive Adult
- Educator
- Student
- CLD Alumni
Grade Level of interested student?
- 4th
- 5th
- 6th
- 7th
- 8th
- 9th
- 10th
- 11th
- 12th
Gender of interested student
- Male
- Female
What would you like more information about?*
- Programs
- Services
- Both, programs and services
Which programs would you like more information about?*
- Business Orientation Project (BOP) (10-12th Grade)
- College Prep (9th-11th Grade)
- College Prep Conference & College Fair (8th-12th Grade)
- Emerging Scholars (10th-12th Grade)
- Imani Book Club (4th-12th Grade)
- Jr. Self-Discovery (4th-6th Grade)
- Parents Chat (Supportive Adults)
- Precious Miss (6th-8th Grade)
- Project MR (7th-10th Grade)
- Rawls Scholars Medicine Initiative (10th-12th Grade)
- Role Model/Advisor Experience (8th-12th Grade)
- SAT Prep (10th-12th Grade)
- Self-Discovery/Career Exploration Project (10th-12th Grade)
- Success Prep (Rising 9th Grade)
- Workshops (4th-12th Grade)
Which services would you like more information about?*
- Guidance Counseling
- Homework Help
- Scholarships Research
- Tutoring
Comments: Let us know if there are other programs or information you would like to receive.
Are you interested in engaging with the CLD Alumni Association and receiving more information from our Alumni Relations Coordinator?*
- Yes
- No
Zip Code*
We always want to know where our participants come from, please let us know your residential zip code.

ZIP Code

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2425 Dr. Martin Luther King Jr. Street,
Indianapolis, IN 46208
317-923-8111

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