Print, complete, and send this form to:

Tom Hill or Betty Taylor
FCAT Summer Success Program
c/o Baker County High School
1 Wildcat Drive
Glen St. Mary, FL 32040

The student will be informed of their enrollment prior to leaving the high school for the summer, and the parent/guardian will receive a confirmation phone call as well.

The student applying is a:

The student has yet to pass:

The student applying is a current student at BCHS:

The student applying understands that this program requires a month-long commitment  to work hard and respectively:

Address:

Address:

City:

State:

Zip Code:

Phone:

E-mail: