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Eureka! Info Session Registration
Please complete the form If you have any questions or concerns, contact Eureka coordinator Marylissa Barbosa-Fish (
mbarbosa@girlsincpa-nj.org
) or Eureka program facilitator Niah Lombo-Sierra (
nlombo@girlsincpa-nj.org
)
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Parent/Guardian Name (First and Last)
*
Your answer
Student's Name (First and Last)
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Student's School
*
Your answer
Are you new to Girls Inc ?
*
Yes
No
Current Girls Inc. program student is in. (If applicable)
Your answer
Are you interested in joining the Eureka! Program?
*
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No
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