Request edit access
2021 MLK Health Fair Pre-registration
* Required
First name
*
Your answer
Last name
*
Your answer
Race/Ethnicity
*
White
Black/African American
Asian
Native American
Hispanic/Latino
Other:
Required
Grade
*
Choose
Kindergarten
1st or 2nd grade
3rd or 4th grade
5th grade
6th + 7th grade
8th + 9th grade
10th + 11th grade
12th grade
Parent / Community Member
Parent/Guardian's name (Elementary students)
Your answer
Parent/Guardian's email address (Elementary students)
Your answer
Homeroom/Science teacher's name
Your answer
Email required for raffle entry. E-GIFT CARDS WILL BE EMAILED TO WINNERS. Elementary school students: enter your parent/guardian's email address. Middle/high school students: enter your personal school email. Please ensure the address is correct.
*
Your answer
Why did you choose to attend this fair? (Please select all that apply).
*
To receive science credit
To learn more about careers in medicine
To gain mentorship from diverse medical students
To do a fun activity on a Friday
To increase my knowledge related to health and wellness
Other:
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of CPA Schools.
Report Abuse
Forms
