the audi[o]smotic sessions REGISTRATION

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We collect this information to support our grant reporting procedures. Understanding the demographics we serve helps us advocate for broader, more accessible programming.

This registration form is for the open sessions June 1-15. You will receive a Zoom link 20 minutes prior to your first session. Please do not share the link, but encourage others who are interested to fill out this registration form!

Email *

First Name *

Last Name *

Pronouns *

Address

Zip Code *

Phone

Professional Identity *

Ethnicity *

America Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native American or America Indian

Native Hawaiin / Pacific Islander

White

Multiracial

Other:

Required

Income Bracket *

Less than $15,000

$15,000–$25,000

$25,000–$35,000

$35,000–$45,000

$45,000–$60,000

$60,000 or more

Required

Disability *

Hearing Disability

Visual Disability

Physical Disability

Mental or Emotional Disability

Other

None

Required

Special Constituency *

College Student

Active Military

Veteran

Senior Citizen

Freelancer/Independent Contractor

Unemployed

Other

None

Required

A copy of your responses will be emailed to the address you provided.

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