High School: Late Class Sign-Up (Session 5 Only)
We're so happy you're interested in CIP Session 5! This sign-up form is for the high school student to complete with their parent/guardian. Both the student participating in Connect-in-Place and their parent/guardian must be present to fill out this form, as it includes a waiver that the parent/guardian must sign.
This form was due by Friday, February 19 at 12:00 noon PDT. Late sign-ups are still being accepted, but there's no guarantee that you'll be placed in a class.
Class Titles and Descriptions are attached here:
https://tinyurl.com/S5HSClasses
IMPORTANT: The more classes you rank, the more likely you are to be placed in a class! Connect-in-Place reserves the right to not place students in any class.
* Required
Email address
*
Your email
Parent Name
*
Your answer
Parent Email
*
Your answer
Parent Phone Number
*
Your answer
Student Full Name
*
Your answer
Student Email (where we should send the Zoom link to)
*
Your answer
Student Phone Number
*
Your answer
Please like/follow our social media accounts for important info on classes and program-wide events!
Facebook:
https://www.facebook.com/connectinplace
Instagram: @connect.in.place
https://www.instagram.com/connect.in.place/
LinkedIn:
https://www.linkedin.com/company/connectinplace/
Have you liked/followed our social media account for important info on classes and program-wide events?
*
Yes, I have already!
I will now!
Which CIP sessions have you attended in the past?
*
Session 1
Session 2
Session 3
Session 4
This is my first session with CIP
Required
How did you hear about us?
*
Your answer
Student's Gender
*
Female
Male
Non Binary
Prefer not to say
Other:
Country of Residence
*
USA
Other:
State
*
Choose
California
N/A: Outside of the US
Alabama
Alaska
Arizona
Arkansas
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
City of Residence?
*
Your answer
Student Age
*
Your answer
Student Grade
*
9th
10th
11th
12th
For the student: How likely are you to attend all your scheduled classes?
*
100% - I am certain I will be there for every lesson!
90% - I am pretty sure I will be there for every lesson
80% - I most likely will be there for every lesson
70% - I can't commit to every lesson
Are you willing to take any class?
*
Yes, I am happy to take any class
No, if I am not placed in one the class preferences I list below, I do not want to be enrolled
Student & Parents: I have read the full class schedule and understand that some classes have special requirements and prerequisites. I understand that if I do not meet these prerequisites, I will be dropped from the class during the first week.
*
Yes I understand I will be dropped from CIP classes if I do not meet prerequisites.
Required
First Choice Class
*
Choose
Introduction to Gender and Development Studies - Nikita, Tu/Th 5-6pm PST
The Science & Politics of HIV - Natalie, Saturday 11am-12pm PST
Learning to Think like a Politician - Robyn, Wednesday 5-6pm PST
Intimate Justice: Reimagining Sex Ed - Grace, Saturday 11am-12pm PST
Marketing 101: Intermediate - Prajval, Saturday 6:30-8:30pm PST
Static Mechanic - Hongjie, Sat/Sun 1-2pm PST
Writing Intervention - Gilbert, Friday 4-5:15pm PST
Homework Help: AP Psychology - Lilli, Tu/Th 4-5pm PST
Homework Help: Biology - Aashnika & Sierra, Tu 5-6pm & Sun 3-4pm PST
Musical Theatre: How to Become a Triple Threat - Hannah, M/W 3:30-4:30pm PST
Costume Design in KPop - Wendy, Monday 3-4pm PST
The Well Rounded Photographer - Zoey, Tu/Th 4-5pm PST
Star Wars: A Cultural Approach Beyond the Screen - Ren, Thursday 4-5:30pm PST
Pre-Health Hour - Vivian & William, Monday 4-5pm PST
The Ultimate Guide to Surviving High School & Beyond - Berkeley Women in Business, Wednesday 4-5pm PST
Cooking in the Dorms - Wendy, Wednesday 3-4pm PST
Second Choice Class
Choose
Introduction to Gender and Development Studies - Nikita, Tu/Th 5-6pm PST
The Science & Politics of HIV - Natalie, Saturday 11am-12pm PST
Learning to Think like a Politician - Robyn, Wednesday 5-6pm PST
Intimate Justice: Reimagining Sex Ed - Grace, Saturday 11am-12pm PST
Marketing 101: Intermediate - Prajval, Saturday 6:30-8:30pm PST
Static Mechanic - Hongjie, Sat/Sun 1-2pm PST
Writing Intervention - Gilbert, Friday 4-5:15pm PST
Homework Help: AP Psychology - Lilli, Tu/Th 4-5pm PST
Homework Help: Biology - Aashnika & Sierra, Tu 5-6pm & Sun 3-4pm PST
Musical Theatre: How to Become a Triple Threat - Hannah, M/W 3:30-4:30pm PST
Costume Design in KPop - Wendy, Monday 3-4pm PST
The Well Rounded Photographer - Zoey, Tu/Th 4-5pm PST
Star Wars: A Cultural Approach Beyond the Screen - Ren, Thursday 4-5:30pm PST
Pre-Health Hour - Vivian & William, Monday 4-5pm PST
The Ultimate Guide to Surviving High School & Beyond - Berkeley Women in Business, Wednesday 4-5pm PST
Cooking in the Dorms - Wendy, Wednesday 3-4pm PST
Third Choice Class
Choose
Introduction to Gender and Development Studies - Nikita, Tu/Th 5-6pm PST
The Science & Politics of HIV - Natalie, Saturday 11am-12pm PST
Learning to Think like a Politician - Robyn, Wednesday 5-6pm PST
Intimate Justice: Reimagining Sex Ed - Grace, Saturday 11am-12pm PST
Marketing 101: Intermediate - Prajval, Saturday 6:30-8:30pm PST
Static Mechanic - Hongjie, Sat/Sun 1-2pm PST
Writing Intervention - Gilbert, Friday 4-5:15pm PST
Homework Help: AP Psychology - Lilli, Tu/Th 4-5pm PST
Homework Help: Biology - Aashnika & Sierra, Tu 5-6pm & Sun 3-4pm PST
Musical Theatre: How to Become a Triple Threat - Hannah, M/W 3:30-4:30pm PST
Costume Design in KPop - Wendy, Monday 3-4pm PST
The Well Rounded Photographer - Zoey, Tu/Th 4-5pm PST
Star Wars: A Cultural Approach Beyond the Screen - Ren, Thursday 4-5:30pm PST
Pre-Health Hour - Vivian & William, Monday 4-5pm PST
The Ultimate Guide to Surviving High School & Beyond - Berkeley Women in Business, Wednesday 4-5pm PST
Cooking in the Dorms - Wendy, Wednesday 3-4pm PST
Fourth Choice Class
Choose
Introduction to Gender and Development Studies - Nikita, Tu/Th 5-6pm PST
The Science & Politics of HIV - Natalie, Saturday 11am-12pm PST
Learning to Think like a Politician - Robyn, Wednesday 5-6pm PST
Intimate Justice: Reimagining Sex Ed - Grace, Saturday 11am-12pm PST
Marketing 101: Intermediate - Prajval, Saturday 6:30-8:30pm PST
Static Mechanic - Hongjie, Sat/Sun 1-2pm PST
Writing Intervention - Gilbert, Friday 4-5:15pm PST
Homework Help: AP Psychology - Lilli, Tu/Th 4-5pm PST
Homework Help: Biology - Aashnika & Sierra, Tu 5-6pm & Sun 3-4pm PST
Musical Theatre: How to Become a Triple Threat - Hannah, M/W 3:30-4:30pm PST
Costume Design in KPop - Wendy, Monday 3-4pm PST
The Well Rounded Photographer - Zoey, Tu/Th 4-5pm PST
Star Wars: A Cultural Approach Beyond the Screen - Ren, Thursday 4-5:30pm PST
Pre-Health Hour - Vivian & William, Monday 4-5pm PST
The Ultimate Guide to Surviving High School & Beyond - Berkeley Women in Business, Wednesday 4-5pm PST
Cooking in the Dorms - Wendy, Wednesday 3-4pm PST
Fifth Choice Class
Choose
Introduction to Gender and Development Studies - Nikita, Tu/Th 5-6pm PST
The Science & Politics of HIV - Natalie, Saturday 11am-12pm PST
Learning to Think like a Politician - Robyn, Wednesday 5-6pm PST
Intimate Justice: Reimagining Sex Ed - Grace, Saturday 11am-12pm PST
Marketing 101: Intermediate - Prajval, Saturday 6:30-8:30pm PST
Static Mechanic - Hongjie, Sat/Sun 1-2pm PST
Writing Intervention - Gilbert, Friday 4-5:15pm PST
Homework Help: AP Psychology - Lilli, Tu/Th 4-5pm PST
Homework Help: Biology - Aashnika & Sierra, Tu 5-6pm & Sun 3-4pm PST
Musical Theatre: How to Become a Triple Threat - Hannah, M/W 3:30-4:30pm PST
Costume Design in KPop - Wendy, Monday 3-4pm PST
The Well Rounded Photographer - Zoey, Tu/Th 4-5pm PST
Star Wars: A Cultural Approach Beyond the Screen - Ren, Thursday 4-5:30pm PST
Pre-Health Hour - Vivian & William, Monday 4-5pm PST
The Ultimate Guide to Surviving High School & Beyond - Berkeley Women in Business, Wednesday 4-5pm PST
Cooking in the Dorms - Wendy, Wednesday 3-4pm PST
For students: are you comfortable turning your video and audio on? (Required for some classes)
*
Yes
No
How many classes would you like to enroll in? (Whether or not you will be placed in multiple classes will depend on how many students enroll in Connect-In-Place, as well as the popularity of the classes you are interested in.)
*
1
2
3
4
5
For the parent/guardian: I have read the attached liability waiver, and agree to the Connect-In-Place terms and conditions.
*
https://docs.google.com/document/d/1r6RH28CbjMnTlaWC15kQg99uUP0zR2rBrcAVsNsoQzo/edit?usp=sharing
I have read and agree to the Connect-In-Place terms and conditions
Required
For the parent/guardian: Please write out your name as a signature that you have read and agree to the Connect-In-Place terms and conditions.
*
https://docs.google.com/document/d/1r6RH28CbjMnTlaWC15kQg99uUP0zR2rBrcAVsNsoQzo/edit?usp=sharing
Your answer
(Optional) For the student: What are you most looking forward to about Connect-In-Place?
Your answer
Any questions or comments?
Your answer
Send me a copy of my responses.
Submit
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