Preferred Name First Name * Last Name * Session Attending Level 1 - Beginner (Tu/Th) Level 2 - Advanced (M/W) Birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Identified Gender - None -MaleFemaleOther Identified Race (Please Select One) * Multiracial American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I prefer not to answer Identified Ethnicity * - Select -Hispanic or Latino or Spanish OriginNot Hispanic or Latino or Spanish OriginI prefer not to answer Preferred Phone Contact * - Select -HomeWorkMobileOther Home Phone Cell Phone Student Email Address * Street Address * City * Zip Code * Parent/Legal Guardian Name(s) * Parent/Legal Guardian Phone Number(s) * Parent/Legal Guardian Email(s) * Parent/Legal Guardian Level of Education - None -Less than High SchoolHigh School/GEDSome CollegeAssociate's DegreeBachelor's DegreeGraduate Degree Emergency Contact Name(s) * Emergency Contact Phone Number(s) * School Name * Grade Level (Starting Fall 2024) * - Select -89101112 Projected High School Graduation Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026202720282029 Number of Persons in Family * 123456789101112131415 Is your family’s income less than $22,590 annually? * This is information needed to help us fund SPOT 127. yes no Do you have any colleges of interest? My future goals are… * Please describe in at least seven sentences. What excites me the most about digital media is… * Please describe in at least seven sentences.
