Xperiential Workshops Registration: Student Information

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We are partnering with Pixar to offer a nine week virtual workshop on Tuesdays and Thursdays, March 8th-May 5th 4pm-6pm. This workshop is open to 13 student ages 13-18. Students will be accepted into the program in the order in which they have applied.

If you have any questions, please contact Kendra Lappin at kendra@826valencia.org.

*Please take note of age restrictions before signing students up for workshops!*

Student's First Name *

Student's Last Name *

Grade *

Date of Birth (please make sure to select the correct year!) *

YYYY

Gender *

Female

Male

Prefer not to say

Non-Binary

Other:

School *

Type of School *

Does your student qualify for Free or Reduced Price Lunch? *

Yes

Don't Know

Student's Email (Optional)

Student's Cell Phone Number (Optional)

Is your student enrolled in an English Language Learner program (ELL/ESL)? *

Yes

If yes, what level has your student been assigned? (Please refer to your latest report card)

Does your student have any special needs (e.g. learning, physical or mental health)? *

Yes

If yes, please explain:

Does your student have an Individualized Learning Plan (IEP)? *

Yes

If yes, please explain:

I give 826 Valencia permission to communicate these needs to volunteers in order to support their work with my student.

Yes

Clear selection

Student's First Language(s) *

Language(s) Spoken at Home *

Race/Ethnicity *

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