Institute Form
Thank you for your interest in joining our Institute! You can learn more about our Institute program here.

For youth ages 10-17 years old, please complete the youth registration form here.

The purpose of this form is to collect the following information:
  • Basic contact information
  • Preferences and access needs
  • Expected attendance at our program events
  • Acknowledgment of program expectations
For those interested in receiving an honorarium, by submitting this form you acknowledge that you understand and commit to our program expectations.

Once the form is submitted and depending on your responses, you will receive an email with additional information and documents to sign.

If you have any questions or need support completing this form, please contact us at (650) 265-1193 or info@speboard.org. Jason Iloreta, our Administrative Assistant and Technology Specialist, will be happy to assist you.
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Email *
Legal First Name (ex: "Amelia") *
Legal Last Name *
Preferred Name (ex: "Milly") 
Preferred Pronouns:
Birth Year: *
Primary phone number *
Primary phone is: *
Primary email address: *
Primary email address is: *
Preferred messaging method(s): *
SPEB would use your preferred messaging method to share announcements, updates, reminders, registration / feedback links, etc. We would also use this method for two-way communication with you.
Required
Mailing Address
Providing this information is optional. SPEB will use your mailing address to mail you items like {honorariums, appreciation letters, donation receipt letters, etc.}
Mailing address
City
State
Zip / Postal Code
Providing your zip / postal code is optional. It will allow SPEB to pursue funding and partnership opportunities that are geography-specific.
Race / Ethnicity (check all that apply)
Providing your race / ethnicity is optional. It will allow SPEB to pursue funding and partnership opportunities that center one or more racial / ethnic groups. Please use the "Other" option to write in a race/ethnicity not listed below (ie: Mexican, Somali, Indigenous (name of indigenous community), etc.)
Institute Role: *
Required
School District *
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