C.I.V.I.C.S Registration Form Question Title * 1. Your Info Name Name of School State Current Grade Email Address Phone Number Question Title * 2. What art forms are you interested in exploring in CIVICS? Poetry Song Writing Visual Arts Other (please specify) Question Title * 3. What current events are you interested in exploring? COVID19 The Wealth Gap LGBTQ Systemic Racism Relationships Homelessness The beauty in your community Politics Abuse Other (please specify) Question Title * 4. Can you commit to attending CIVICS every Wednesday at 4PM? Yes No Maybe Question Title * 5. How do you identify? (Choose all that apply) Gender Fluid Transgender Cis-Gender Non-binary None of these Female Male Not Sure Question Title * 6. If you join us, we will need to contact your parent or guardian to let them know about your participation in the #Lifegoals Lab. Name Email Address Phone Number Done