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STEM Team Permission Slip
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
*
Your answer
Last Name
*
Your answer
Career Interest 1
*
What do you want to be when you grow up? (either put what you know you want to be or something you've CONSIDERED in the past. You're not locked in. It's just a question.
Your answer
Career Interest 2
*
What's another job or career you'd want to do when you grow up? (again, either put what you know you want to be or something you've CONSIDERED in the past. You're not locked in. It's just a question.
Your answer
Grade
*
What year of high school are you in this year?
Freshman (9th)
Sophomore (10th)
Junior (11th)
Senior (12th)
City
*
What city do you live in?
Your answer
Zip
*
What is the zip code of our home?
Your answer
Address
*
What is the house number, street, and apartment number for your home?
Your answer
Parent Phone Number
Your answer
Birth Month
*
What month is your birthday?
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Date of Birth
*
What day of the month is your birthday?
Your answer
Birth Year
*
In what year were you born?
Your answer
Gender
X
Male
Female
X
Male
Female
Clear selection
Ethnic Background
X
Black/ African American
Native American
Alaska Native
Asian
Caucasian/ White
Hispanic/ Latino
Pacific Islander
Other
X
Black/ African American
Native American
Alaska Native
Asian
Caucasian/ White
Hispanic/ Latino
Pacific Islander
Other
Clear selection
Free or Reduced Lunch
*
Do you get free or reduced lunch?
Yes
No
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