Excel Youth Academy Camp REGISTRATION - October 28th, 2023

Thank you for your interest in our upcoming workshop! We ask that a parent/guardian complete the registration for the student.

The student registered for the workshop must be Kindergarten - 12th grade.

Parents are not required to stay on-site during the workshop.

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* 1. Student's Last Name

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* 2. Student's First Name

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* 3. Student's Email Address

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* 4. Student's Phone Number - Cell is Preferred.

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* 5. What school does the student attend?

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* 6. What is the grade level of the student?

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* 7. Student's YEAR of birth

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* 8. Student's Gender

Female

Male

Non-Binary

Other

I prefer not to answer

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* 9. Student's Ethnicity/Race

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latinx

Native Hawaiian or Other Pacific Islander

White

Multi-Racial

Prefer not to answer

Other (please specify)

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* 10. Student's County of Residence

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* 11. Student's ZIP Code of Residence

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* 12. Parent's Last Name

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* 13. Parent's First Name

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* 14. Parent's Email Address

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* 15. Parent's Phone Number - cell number is preferred. This number needs to be the same phone number that Inspiredu can have on file as the emergency contact number for the day of the workshop.

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* 16. How many children (ages 0-17) live in your household?

More than 5

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* 17. How many adults live in your household?

More than 5

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* 18. What language is spoken most often in your home?

English

Spanish

Prefer not to answer

Other (please specify)

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* 19. How many computers (desktop, laptop, or tablet) are in your home? Please include both those you own and those that may be on loan to you from a school and/or organization.

None

More than 3

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* 20. Of the computers in your home, how many do you/your family own?

There is not a computer in my home.

I/my family DO NOTOWN any of the computers in my home.

I/my family OWN SOME OR ALL of the computers in my home.

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* 21. What type of Internet access do you have at home?

NO Internet access at my home.

Internet access only from a cell phone

Internet access through broadband, fiber, or cable provider (examples: Comcast, Xfinity, AT&T, etc) or unsure of the type

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* 22. What is the highest level of formal education completed by a parent/guardian in the home?

Completed some High School

Earned a High School Diplomas, GED, or Equivalent

Completed a Technical School Certification or Career/Job Training Program

Completed some College

Earned a College Degree

Prefer not to answer

Other (please specify)

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* 23. Annual Household Income

$10,000 or less per year

$10,001 - $20,000 per year

$20,001 - $25,000 per year

$25,001 - $35,000 per year

$35,001 - $50,000 per year

$50,001 - $75,000 per year

More than $75,000 per year

Prefer not to answer

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* 24. Our goal is for all learners to be comfortable when attending our workshops. Does your child have any needs that we may be able to accommodate? (Example – mobility, vision, hearing, etc)