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CLINCH VALLEY COMMUNITY ACTION
Project Discovery Application

Please Complete All of the fields of the applications and mark if the information is Not Applicable (N/A).  Failure to provide information could cause delay in enrollment.

Student Information
Disabled
Do you need an interpreter?
Which high school district do you live in?
Household Information
Do you need an interpreter?
Veteran Status
Health Insurance
Do You Receive
Are you currently employed?
Housing Statuspick one!
Current family type:Select One
Family Questionnaire
Did mother of child complete:
Did mother of child complete:
How do you and your child feel about school now?
How do you and your child feel about going to college?
As a parent, when do you think about helping your son or daughter get into college, would you say that you:
Media Release

By initializing the box(es), I the undersigned acknowledge that I am a member of Project Discovery and that I nor any representative of Project Discovery, will receive compensation for this media contact.  I consent and agree to the following media release, for the purpose of, advertising and marketing.

Please select the items that you consent to according to the above statement.

I certify that the above information is correct and may be used for statistical and eligibility purposes only.  In addition, by signing this I give permission for my child to (1) participate in the Project Discovery program and (2) media release information above.

Proof of income for household for 30 days is required to be attached to the application.  A png, jpeg or tiff can be uploaded as well. Thank you.

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