T-ATP 2026 Summer Cybersecurity Workshop Intake Form
Intake form for our Summer 2026 Cybersecurity Workshop at Johnson C. Smith University (JCSU). 
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Child's First Name *
Child's Last Name *
Email *
Full Street Address (Street Number and Street Name) *
City *
State *
Zip *
Phone number *
Grade level of child *
Age of child *
Child's Birth Month and Year (MM/YYYY) *
School Child is Attending *
Race of child *
Gender Identity of child *
Does your child own a laptop?
NOTE: If your child has a Chromebook provided by CMS or share a computer please select No.
 *
How did you hear about T-ATP cybersecurity workshop? *
If the previous answer was Other, please describe where you learned about T-ATP's cybersecurity workshop *
For students who are 18 and under: 

I hereby grant The Accelerated Training Program (T-ATP) to use my name, image, and likeness in marketing materials, photos, and videos. This includes videos, still images and voice. I hereby release and discharge the producer from all claims and demands arising out of or in connection with the use of the images, recordings and my identity, including without limitation any and all claims for libel, privacy, or publicity. 

I have read the foregoing and fully understand the contents thereof.
 *
For students under 18:

Parent / Guardian Signature - First and Last Name

Note: This will be used as an electronic signature for this form.
 *
Students who complete the workshop will receive a certificate of completion. Please type your child's name (First Name and Last Name) as you would like to see it on the certificate. *
On a scale of 1 to 10, where 1 is little knowledge and 10 is advanced knowledge, what is your child's proficiency in cyber hygiene? *
On a scale of 1 to 10, where 1 is little knowledge and 10 is advanced knowledge, what is your child's proficiency in cyber fundamentals? *
On a scale of 1 to 10, where 1 is little knowledge and 10 is advanced knowledge, what is your child's proficiency in computer programming with Python? *
On a scale of 1 to 10, where 1 is little knowledge and 10 is advanced knowledge, what is your child's proficiency in artificial intelligence (AI)? *
I acknowledge my child is between the ages of 13-18. *
Required
I acknowledge that my child needs to attend all classes.  Failure to do so will result in my child being dropped from the workshop and not receiving a laptop. *
Required
I acknowledge that my child needs to complete all coursework during the workshop.  Failure to do so will result in my child being dropped from the workshop and not receiving a laptop. *
Required
I acknowledge that my child needs to stay for the entire workshop time (3:30 pm-4:30 pm on Tuesdays and Thursdays).  Failure to do so will result in my child being dropped from the workshop and not receiving a laptop. *
Required
I acknowledge that I understand there are twenty (20) slots for the 2026 Summer Workshop and if my child enrolls once the twenty (20) slots are filled they will be placed on a waiting list. *
Required
I acknowledge that if my child enrolls after 12:00 pm (EST) on June 3, 2026, they will be ineligible to participate in the workshop, and will not receive a laptop. *
Required
I acknowledge that the workshop will have classes on Tuesday and Thursday from 3:30 pm-4:30 pm even if Charlotte-Mecklenburg Schools (CMS) are out for holidays or breaks. Failure to have my child attend class will result in them being dropped from the workshop and not receiving a laptop. *
Required
I acknowledge that the information provided is correct to the best of my knowledge. If the information is found to be incorrect, I/my child will be ineligible to participate in the workshop, and will not receive a laptop. *
Required
I acknowledge that the name provided for the certificate of completion is correct and the name provided will be printed on the certificate of completion. *
Required
I acknowledge that T-ATP can drop my child from the workshop at any time and my child will not receive a laptop if they display but not limited to the following conditions: 
1. Not completing coursework
2. Unexcused absences
3. Leaving class early
4. Providing false information
5. Disruptive behavior
 *
Required
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