21st CCLC Recruitment Form

Person Completing Form:

Site:

• Capitol Elementary
• Capitol Middle
• Magnolia Woods

Student Name:

Who was contacted? (student, guardian, etc.)

When were they contacted?

How were they contacted?

• Phone Call
• Email
• Flyer
• Letter
• Home Visit

If you listed other on the previous question, please explain your answer.

Did student(s) enroll?

• Yes
• No