Club Signup Form
This application can be used to start a new Club through Deaf Kids Code.
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What is your name?
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What is your birthday?
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What is your email address?
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What is your mobile phone number?
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Where will your new club be hosted (country and state if applicable)?
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Deaf Kids Code requires:

1. Our Clubs must be hosted by an educator or staff member affiliated with a recognized educational institution.

2. Clubs are not permitted to charge any fees for participation.

Do you concur?

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I'm applying to start a Club at a:

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School Type:

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What is the lowest grade level that your host school or organization serves?
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What is the highest grade level that your host school or organization serves? *
What is the name of your Host Organization? This will also be your Club's name by default. Example: West Seattle High School, Carroll High School, etc. *

As per our requirements, our clubs need to be overseen by an educator or staff member who is associated with an officially recognized educational institution. To proceed, it's necessary for you to have an affiliation with this institution. If not, you must find someone from the institution who can host this organization. Is this applicable in your situation?

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When do you expect to hold your first Club meeting?

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Please tell us a bit more about yourself.

Why do we ask these questions? Deaf Kids Code collects this data for our internal business purposes, including for data analysis and audits. We may use this data, in conjunction with other sources of data to assess the quality and impact of our programs and make ongoing program planning and improvements.

Race/Ethnicity:

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Your Current Job Title/Occupation (please select the closest available option, or select "Other"):

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How did you first hear about Deaf Kids Code? 

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We'd like to learn more about your Club's Host Organization. Please answer the questions below:

Is your Host Organization a Title I institution? "Title I" designates schools that serve a high percentage of low-income students.

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What is your Club Host Organization's address? This address should be the physical location of your Club.

Street Address:
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Street Address Line 2:
City:
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State/Territory:
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ZIP/Postal Code:
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Do you plan to hold your Club sessions in person or online?

If you aren't certain or anticipate your plans may change, please select "A combination of in-person and virtual".

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How many participants do you anticipate for your Club(s)? It's okay to estimate.

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Deaf Kids Code is committed to serving students from historically underrepresented groups in tech; these questions help us understand our programs' reach and impact.


Approximately what percentage of students affiliated with your school/organization would identify low income (as determined by eligibility for free and reduced price lunch):

Clear selection
Approximately what percentage of students affiliated with your school/organization would identify as  students from underrepresented minority groups (including Black/African American, Hispanic or Latinx, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and Multiracial)
Clear selection
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