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1. Contact Info (Required.)

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2. Age (Required.)

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3. Ethnicity (Required.)

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4. School Info (Required.)

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5. Grade (Required.)

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6. Were you a former Scientific Adventures for Girls student?

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7. Would you like to be a paid Scientific Adventures for Girls Near Peer/Teaching Assistant? (Required.)

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8. Would you like learn more about this? (Required.)

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9. What areas of STEM are you most interested in? (check all that apply) (Required.)

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10. Rank in order of preference the following activities and resources that you would like to see in the Scholar Club.  Use the up and down arrows to sort the list from first choice to last. (Required.)

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11. Please note what other workshop or activity you would like to engage in

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12. Please check the 4 areas you are most interested in (Required.)

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13. Do you have any other needs or ideas not mentioned above that you would like to see in the Club?

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