Summer at City Hall * 2017 STUDENT INFORMATION Question Title * 1. Participant's Name (First and Last) Question Title * 2. School Question Title * 3. Grade (grade you are entering Fall 2017) 11th 12th Other Question Title * 4. Gender Female Male Other Question Title * 5. Student’s School ID Number Question Title * 6. Birthdate Question Title * 7. Age Question Title * 8. Student’s Cell Phone (if applicable) Question Title * 9. Student’s E-Mail Address Question Title * 10. Home Address (Street, City, Zip) Question Title * 11. Has participant been a PRO participant before? Yes No Question Title * 12. What are the best ways to reach the participant? Text Email Call Other: Question Title * 13. List any food allergies, special considerations, or needs we should be aware of. Question Title * 14. How did you hear about the program? Question Title * 15. What is the participant’s T-Shirt size? XS S M L XL XXL STUDENT DEMOGRAPHICS (Optional)This information is used for grant reporting purposes and has no impact on the student's application status. Question Title * 16. Race/Ethnicity African American/Black Asian or Asian American Hispanic or Latino Native American or Alaska Native Native Hawaiian or Pacific Islander Multiracial or Multiethnic White (not Hispanic) Other: Question Title * 17. Primary Language Spoken at Home Chinese English Hmong Russian Spanish Tagalog Vietnamese Other: Question Title * 18. Does the student receive free/reduced cost school meals? Yes No Question Title * 19. Did either of the student’s parents/guardians attend college? Yes No Question Title Submit your application!
