Nomination Form

Any educator or parent familiar with the student may complete the form below to nominate a student for our program. There is no cost to nominate a student. No information obtained here is used for any purpose other than relaying information to the nominated student's family. Please complete as much information as possible. Although not required, in order for us to process this nomination, we need an e-mail, phone number or address.

Student Information
Please enter the first name of the student's parent(s). If you don't know it, please enter "Parent of (first name of student)" here.
Please enter the last name of the student's parent(s). If you don't know it, please enter the student's last name here.
For other, please enter here.
Please enter the school the student currently attends, here.
Please enter the school district, if applicable.
Additional Comments
Does the student qualify for free or reduced lunch (optional, if known)?
If the student lives in the Rolla area, click "Yes" below to provide information on Project MEGSSS' after-school program in Rolla.
Perhaps your child doesn't quite fit within our guidelines? We leave it to the parents and educators who know them best to make recommendations to MEGSSS. Please comment here if you want us to have any more information about your child.
Teacher Nominations
This information is helpful in the event that there are questions about student qualifications for the program. If a teacher is not involved in the nomination, you may skip this section, fill in the CAPTCHA, and press the "Submit" button below to submit this form.
For other, please enter here.

Thanks for nominating your student for Project MEGSSS! Once you fill in the CAPTCHA and press the submit button below, a confirmation e-mail will be sent to both parent and teacher e-mail addresses (if provided). If you experience problems with a nomination, please contact our office at 314.842.5968.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
More information?