First name *

Last name *

What High School do you go to?
Please SelectHigh School AHigh School BOther

Student I.D.

Email *

Phone number

What language(s) are you most comfortable speaking? *
EnglishSpanishEnglish & SpanishOther

Street address *

City *

State/Region *

Postal code *

Gender
Please SelectFemaleMaleNon-binaryPrefer not to say

Date of Birth *

Do you have a laptop? *

[radio* laptop use_label_element "Yes" "No"]

Do you have Wi-Fi at home?

YesNo

What do you want to do after high school?

What are your favorite activities outside of school?

What are you looking to get out of this course?
Skills that will help me in collegeSkills that will help me get a jobSkill that will help me figure out what I want to do nextLearn lifelong entrepreneurial skillsStart a business that benefits the communityLearn leadership and decision-making skillsOther reason

How did you hear about this program?
TeacherPrincipalSchool Flyer/AnnouncementSchool EventInstagramFriends/FamilyOther

Do you have any food allergies or dietary restrictions? *

[radio* allergies use_label_element "Yes" "No" "Not Sure"]

Best way to contact me is: *
PhoneEmailTextOther

Parent/Guardian First Name *

Parent/Guardian Last Name *

Emergency Contact Number *

Parent/Guardian Email

First Name *

Last Name *

Email Address *

Phone *

Best way to contact you *

[radio* contact-way use_label_element
"Phone Call"
"Text Message"
"Email"
"Other"
]

How did you hear about us? *

[radio* hear-about use_label_element
"Friend"
"Family"
"Google"
"Referral"
"Other"
]

Services *
Business FilingWeb DevelopmentWeb HostingAccounting AssistanceGraphic DesignPOS SystemGoogle My BusinessAdvertisement & PromotionPublic Speaking & PitchingProduct Studio Shoot

Any notes about budgets, timelines and details of the project *

Do you have a website? If yes, write below.