Registration Form: Career Connections

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Registration Form: Career Connections | STEM

Thank you for your interest in participating in the virtual Career Connections- STEM Experience on Thursday, May 20, 2021, from 1:30-3:00 PM. To register, please complete the form below. The registration deadline is Monday, May 10, 2021 or until spots are filled.

Following registration, participants will be asked to complete agency intake forms. Once the paperwork is returned to Independence, Inc., participants will receive an email notification with the details on activity kit delivery or pick-up.

For more information or questions, please contact Independent Living Specialist, Trampes Brown at trampes@independencecil.org or call 701-839-4724.

Note: Supplies are intended for class use only. Registrants are expected to log-in and participate in the online career exploration experience via Zoom.

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

YYYY

Please indicate the county in which you reside *

Name of School *

Anticipated High School Graduation Year *

Please indicate if you are a person with a disability (e.g. physical disability, mental health condition, chronic illness, degenerative disease, learning or cognitive disability, phobia, brain injury). *

Yes

No- ('Career Connections' is a class ONLY available to people with disabilities at this time. Please visit our website, www.independencecil.org and Facebook page for information on upcoming public events and activities.)

Please submit at least (1) question to ask the employer during the experience below. *

Ex. What skills are required to be a meteorologist?

I agree to log-in to Zoom and participate in the experiential learning activity on Thursday, May 20, 2021 at 1:30 P.M. *

Yes

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