To send a sponsorship request for your child please complete and submit the form on this page.

By sending this request for sponsorship from Cognitive First you are confirming that either the child listed on this form is currently qualified for reduced price or free meals in the school he or she attends or you are stating that your current household income falls within the limits of the chart on this page or both:

My child is eligible for reduced price or free Child Nutrition Program benefits. I am requesting sponsored access to a one year license for my child to do the BrainSkills Program which has a retail value of $495. Based upon access being approved and granted I understand that I am under no obligation to pay for the program.

I also understand that if I am approved for sponsorship my sponsored value of the program is reduced to $300 by Cognitive First and that either now or as it is within my means to do so a monthly or one time online or mailed contribution to Cognitive First of any amount toward the sponsored value will be used to extend program sponsorship for a child in another family that also meets the income eligibility guidelines.

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Means qualified requests to Cognitive First are considered subject to program sponsorship availability at the time of your request.

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Name: *

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Child's Name and Age: *

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Is your child currently doing cognitive skill training with an independent firm or an individual? *

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