Navigator PREP Jr. Registration

  • To register for the Navigator PREP Jr. program, please complete and submit the form below. Completion of this form guarantees a spot in the selected program. Final enrollment is contingent upon receipt of program tuition.


    Student Information


  • Parent/Guardian Information


  • Additional Information

    The below questions help us create an individualized transition plan for each participant.

  • (e.g.: Counselor, Tutor, Executive Functioning Coach, Educational Consultant)

  • Program Selection


  • Signature and Disclosure

  • Date Format: MM slash DD slash YYYY