Do you know a child who would benefit from Hope for Opelousas?

At this time, our programs are full. However, please fill out the form below so that you can be placed on our wait list.  Our wait list is first come, first served when we get openings.  Please give us all applicable contact information so that we can contact you when there is an opening. 

Student's Information
Student Name *
Student Name
Today's Date
Today's Date
(If applying during the summer please give us the grade the student will be in the following school year).
Date of Birth
Date of Birth
Student's primary home address *
Student's primary home address
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Address
Parent/Guardian Address
(If different than the child's)
Parent/Guardian Cell Phone *
Parent/Guardian Cell Phone
Parent/Guardian Alternate Phone Number
Parent/Guardian Alternate Phone Number
Parent/Guardian Work or Home Phone number
Parent/Guardian Work or Home Phone number
Education
Learning Disabilities