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.

Question Title

1. Student's Last Name (Required.)

Question Title

2. Student's First Name

Question Title

3. Student's Email Address

Question Title

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

Question Title

5. What school does the student attend? (Required.)

Question Title

6. What is the grade level of the student? (Required.)

Question Title

7. Student's YEAR of birth (Required.)

Question Title

8. Student's Gender (Required.)

Female

Male

Non-Binary

Other

I prefer not to answer

Question Title

9. Student's Ethnicity/Race (Required.)

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)

Question Title

10. Student's County of Residence (Required.)

Question Title

11. Student's ZIP Code of Residence (Required.)

Question Title

12. Parent's Last Name (Required.)

Question Title

13. Parent's First Name (Required.)

Question Title

14. Parent's Email Address (Required.)

Question Title

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. (Required.)

Question Title

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

More than 5

Question Title

17. How many adults live in your household? (Required.)

More than 5

Question Title

18. What language is spoken most often in your home? (Required.)

English

Spanish

Prefer not to answer

Other (please specify)

Question Title

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. (Required.)

None

More than 3

Question Title

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

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.

Question Title

21. What type of Internet access do you have at home? (Required.)

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

Question Title

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

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)

Question Title

23. Annual Household Income (Required.)

$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

Question Title

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)

Excel Youth Academy Camp REGISTRATION - October 28th, 2023

Question Title

* 1. Student's Last Name (Required.)

Question Title

* 2. Student's First Name

Question Title

* 3. Student's Email Address

Question Title

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

Question Title

* 5. What school does the student attend? (Required.)

Question Title

* 6. What is the grade level of the student? (Required.)

Question Title

* 7. Student's YEAR of birth (Required.)

Question Title

* 8. Student's Gender (Required.)

Question Title

* 9. Student's Ethnicity/Race (Required.)

Question Title

* 10. Student's County of Residence (Required.)

Question Title

* 11. Student's ZIP Code of Residence (Required.)

Question Title

* 12. Parent's Last Name (Required.)

Question Title

* 13. Parent's First Name (Required.)

Question Title

* 14. Parent's Email Address (Required.)

Question Title

* 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. (Required.)

Question Title

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

Question Title

* 17. How many adults live in your household? (Required.)

Question Title

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

Question Title

* 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. (Required.)

Question Title

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

Question Title

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

Question Title

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

Question Title

* 23. Annual Household Income (Required.)

Question Title

* 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)

1. Student's Last Name (Required.)

2. Student's First Name

3. Student's Email Address

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

5. What school does the student attend? (Required.)

6. What is the grade level of the student? (Required.)

7. Student's YEAR of birth (Required.)

8. Student's Gender (Required.)

9. Student's Ethnicity/Race (Required.)

10. Student's County of Residence (Required.)

11. Student's ZIP Code of Residence (Required.)

12. Parent's Last Name (Required.)

13. Parent's First Name (Required.)

14. Parent's Email Address (Required.)

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. (Required.)

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

17. How many adults live in your household? (Required.)

18. What language is spoken most often in your home? (Required.)

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. (Required.)

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

21. What type of Internet access do you have at home? (Required.)

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

23. Annual Household Income (Required.)

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)