2017 ChickTech Chicago Nomination Form
NOMINATIONS OPEN UNTIL 10/21/2017

The following is a form to nominate young women in their sophomore and junior years of high school to ChickTech Chicago's yearly program. As part of the program, these young women will have access to engaging educational workshops, one-on-one mentorship, and the chance to land a summer internship.

Program Kick-off Details:
When:
November 18 and 19 2017
9:00 AM - 5:00 PM each day

Where:
Columbia College Chicago
1104 S Wabash
Chicago, IL 60605

Followed by monthly workshops from December to September's Graduation from the program.

For more information, visit our website at http://chicago.chicktech.org.

Student's First and Last Name
Your answer
Student's Grade
Student's High School
Your answer
Student's Email
Your answer
Nominator Name (If you are nominating yourself enter "self")
Your answer
Nominator Email (If you are nominating yourself, enter your email again)
Your answer
Has this student taken any technical courses that your school provides?
Do you think that this student would benefit from the program?
Does this student show an interest in STEM or a STEM career?
Is this student on free, reduced, or full-priced lunch?
Can you describe a moment when this student worked hard to exceed expectations in the face of adversity?
Your answer
Does this student currently hold any leadership positions in their high school or community's programs?
Your answer
Would you like to receive the ChickTech Chicago Email Newsletter?
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