Enroll a Student KING Application

In order to enroll a student in KING please fill in all the following fields.

  1. The first section is regarding the student.
  2. The second section is regarding the team that supports them.
  3. The third section is regarding their preferences for the KING program. 

This section is for information regarding the STUDENT

Please note: all fields with an are required.

Preferred Name:



Race and Ethnicity:

Preferred Language:
Speak Spanish:

Interests and Hobbies:
School Name:
School District:


Please fill in the information for where the student lives. We will contact them directly to set up lessons.

Placement Name (full name):
Placement Email:
Placement Phone:

Please fill in all applicable information regarding the studen'ts Child Welfare Team:.

Case Worker Name:
Case Worker Email:
Caseworker Phone Number:
Caseworker County:

CASA Name:
CASA Email:
CASA Phone:

AAL Name:
AAL Email:
AAL Phone:

Case Manager Name:
Case Manager Email:
Case Manager Phone:

Please fill in YOUR information (for agency, if you are related to the student put in your relationship).

Referrer's Name:
Referrer's Email:
Referrer's Phone:
Referrer's Agency:

Please select the top 3 instruments the student is interested in learning (in order to select multiple hold down the command or window key while selecting)

Instrument Interest:

Does the student own the instrument they are most interested in playing?

Own Instrument?:

Does the student have a preference of gender regarding their mentor?

Gender Preference?:

If you are not brought to a thank you page, the form did NOT submit. Please check that ALL required fields are filled out.