Step 1 of 3 33% Student Registration InformationStudent Name* First Last Student Email* Student Birth Date* Month Day Year Student Gender* Male Female Name of Previously Enrolled School Student Grade Level for Upcoming Year*9th Grade10th Grade11th Grade12th Grade Student Pre-Survey QuestionsHow many hours a day do you spend on a computerized device? (Computer, Cellphone, Tablet etc.) 0 - 5 5 - 10 10 - 15 15 - 20 Which areas of technology are you mostly interested in and would like to grow your skills in (Please check your top two) 3D Modeling Cybersecurity Game Development Web Design Robotics Virtual Reality Tell us why these areas are interested to youWhat tools / software have you used in these areas of technology?What you have achieved in these areas of technology? (Awards, Projects, Research etc.) Parent Registration InformationParent/Guardian Name 1 First Last Parent/Guardian Name 2 First Last Parent/Guardian Email Parent/Guardian Phone 1Parent/Guardian Phone 2Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
