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    Applicationform

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    This document contains a registration form for the NCWIT AspireIT K-12 Outreach Program Islands Tech Girls. It requests information such as the participant's contact details, medical information, emergency contacts, and demographics. It also includes short questions about the participant's previous experience with computing or robotics programs and what they hope to gain from this program.

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    Applicationform

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    api-356718992
    57 views2 pages
    This document contains a registration form for the NCWIT AspireIT K-12 Outreach Program Islands Tech Girls. It requests information such as the participant's contact details, medical information, emergency contacts, and demographics. It also includes short questions about the participant's previous experience with computing or robotics programs and what they hope to gain from this program.

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    This document contains a registration form for the NCWIT AspireIT K-12 Outreach Program Islands Tech Girls. It requests information such as the participant's contact details, medical information, emergency contacts, and demographics. It also includes short questions about the participant's previous experience with computing or robotics programs and what they hope to gain from this program.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    57 views2 pages

    Applicationform

    Uploaded by

    api-356718992
    This document contains a registration form for the NCWIT AspireIT K-12 Outreach Program Islands Tech Girls. It requests information such as the participant's contact details, medical information, emergency contacts, and demographics. It also includes short questions about the participant's previous experience with computing or robotics programs and what they hope to gain from this program.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    NCWIT AspireIT K-12 Outreach Program

    Islands Tech Girls

    General Information:
    Todays Date____________________
    Participant Full Name ______________________________________________________________________
    Mailing Address ___________________________________________City_____________________________
    State Zip Code______________

    Participant Phone_____________________________ Participant Email ______


    Date of Birth_______________________________
    School (in upcoming school year) _______________________________
    Grade (in upcoming school year)
    Shirt size (adult size, XS, S, M, L, XL, XXL): ___________
    Medical Information:

    Medical Issues/Restrictions/Allergies Yes No If yes, please explain


    _________________________________________________________________________________________________
    _________________________________________________________________________________________________

    Medications Yes No If yes, please explain


    _________________________________________________________________________________________________
    _________________________________________________________________________________________________

    Information on Parent/Guardian 1:

    First Name___________________________________Last Name____________________________________

    Relationship: _____________________________________________________________________________

    Address ________________________________________________ City__________________________

    State Zip Code________________________________________

    Cell Phone_____________________________ Work Phone_____________________________________

    Parent Email_______________________________________________________________________________

    Information on Parent/Guardian 2

    First Name___________________________________Last Name____________________________________

    Relationship: _____________________________________________________________________________

    Address ________________________________________________ City__________________________

    State Zip Code________________________________________

    Cell Phone_____________________________ Work Phone_____________________________________

    Parent Email_______________________________________________________________________________
    1
    EMERGENCY CONTACT 1 (To be contacted if Parent/Guardians are not able to be reached Parents:
    Please do NOT list yourselves)

    First Name___________________________ Last Name______________________________

    Relationship to your daughter ___________________________

    Cell Phone______________________ Work Phone______________________ Ext________

    EMERGENCY CONTACT 2 (If you have a second, please provide it here)

    First Name___________________________ Last Name______________________________

    Relationship to your daughter ___________________________

    Cell Phone______________________ Work Phone______________________ Ext________

    Demographics (Optional: Demographics are collected to create anonymous summaries of participants


    for funders.) Please choose all that apply.

    African American/Black
    Asian/Pacific Islander
    Hispanic/Latina
    Multi-Racial
    Native American/Alaska Native/American Indian
    White/Caucasian
    Person with Disability
    Other
    I prefer not to answer

    I qualify for free/reduced lunch program at my school.


    I do not qualify for free/reduced lunch program at my school.
    I prefer not to answer

    Questions for Program Participant:


    Have you ever participated in computing or robotics classes, camps or training in the past?
    What was it?

    What are three key things you would like to gain from this program?

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