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Create Initiative Application -
Requirements: Middle School Students, Available 6/26 - 7/20 | 9:00 a.m. - 2:00 p.m.
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CETAT
Parent(s) / Guardian(s) Name
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Your answer
Cell Phone (parent / guardian)
Your answer
Email Address (parent / guardian)
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Your answer
Participants First Name
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Your answer
Participants Middle Name
Your answer
Participants Last Name
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Your answer
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Date of Birth
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MM
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DD
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YYYY
Gender
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Female
Male
Race
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Asian
Black / African American
Hispanic / Latino
Native American / Pacific Islander
White
Other
Name & Address of Last School Attended
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Your answer
Technology Interests (Check all that apply)
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Photography
Video Production
Computer Programming
Music
Web Development
Required
Describe your experience level in chosen area(s) of interest
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How did you hear about the program?
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