Parent/Guardian Recommendation and Consent Neurodiverse Learners (NNL) Program

This form is part of the application packet for the Neuroscience for Neurodiverse Learners (NNL) Program. To learn about the other components of the program, visit the Summer Program page.

You can also access the full application in Spanish, Russian, or Vietnamese.

Instructions: A parent or guardian must complete the form below and the short essay questions.

Primary Parent/Guardian Contact Information
Please use the format XXX-XXX-XXXX