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Child Enrollment Application for USucceed

If you are the parent or guardian of a child in grades 8-12 and would like your child to participate in the LSS USucceed mentoring program, please complete the fields listed below and click "Send Now" at the bottom of the page. If you would like to enroll more than one child, please complete a form for each person. Printed enrollment forms are available upon request.

If you do not receive a confirmation email within 48 hours confirming the application went through successfully, please contact LSS USucceed at 605-444-7803. 

Fill Out the Application to Enroll Your Child in USucceed Mentoring

Contact Information

Child Gender
Country
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Preferred contact method:
Does the child spend significant time at a different residence
Country
Address Line 1
Address Line 2
City
State/Province
Postal Code





Matching Information


By signing, you understand that you hold your child's school district, its schools and staff, and Lutheran Social Services of South Dakota, its staff and mentors, free of liability in the event of any results or developments occurring as part of their efforts on your behalf or the behalf of your son/daughter/guardian student. Thank you!