21 Ethos: Tech Camp Application Form
Please complete this form to register for 21 Ethos 2021 Summer Program. Please answer each question to the best of your ability.

IMPORTANT: You are required to attend each day for the duration of the program unless given written notice. Failure to attend a class may make you ineligable for future programs.
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Email *
I am:
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Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent Information: Contact Number #
Full Mailing Address: (Street Number, City, State, and Zipcode) Apt #. *
What is the best way to reach you? *
Student First Name *
Student Last Name *
Age of Participant *
Gender *
Race/Ethnicity *
Were you eligible to receive free or reduced-cost lunch? *
Name of School Student attends *
Student answer: What are your career goals? *
What do you hope to learn from this program?
What programs are you interested in? *
Required
How did you hear about 21 Ethos Summer Program? *
Have you attended a 21 Ethos workshop or program in the past? *
Household Income (This helps us better understand our demographic for funding purposes) *
Use the space below to write a few sentences explaining why you are applying for this program:
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