Coding Registration (Thurs. 7:30 - 9:30PM from 6/30 to 8/4/22)

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Full responses required to enroll in this SDGSAT program

Student First Name *

Student Middle Initial (Enter "X" if you have no middle name) *

Student Last Name *

STUDENT'S Cellphone # (you MUST reply to our text msg within 24 hours to complete your registration. You MAY provide Instagram/Facebook ID instead if you do NOT own a cellphone)

How did you hear about this course? *

Name of Student's School: *

Your Current Grade (as of Fall 2021). [Min 8; enter 13 if Graduated HS] *

Please check ANY of the following which MIGHT interest you as a potential career (Try to pick at least one before selecting NONE) *

Accounting / CPA

Auto Mechanic

Computer Programming or Data Science

Education ( Teacher / Teaching Assistant)

Electrician

Finance (Financial analyst or "Wall Street" job)

Health Care (Nursing, PA, MD, Occ. Therapist, Dentist, Pharmacist, Medical Technician)

Insurance Underwriter

Mathematics / Actuarial Science

Marketing / Advertising / Media / Communications

Plumber

Police Officer or Firefighter

Video/Computer Game Designer ("Game Science")

Sorry, none of these choices interests me.

Required

Approximately how many hours per week do you spend on SCHOOL-related extracurricular activities? Round to nearest WHOLE number. *

Approximately how many hours per week do you spend on OTHER (not school-affiliated) extracurricular activities? Round to nearest WHOLE number. *

Parent/Guardian name (First & Last): *

Parent/Guardian email address: *

Residence Address (include Apt #; skip zip code) or enter NONE if no permanent residence : *

Residence Zip Code: (enter 00000 if None) *

Does your family... *

Live here for free (Gov't or others pay for it)

Rent this residence

Own this residence

How many years have you lived in your CURRENT state (usually NY, BUT not always) ? Round to nearest year. *

Check ALL items below for which you qualify : *

Free school lunch

Reduced price school lunch

SAT exam fee waivers (do NOT check for NYC's SAT school day; "everyone" gets that).

Excelsior (Free SUNY/CUNY tuition if Family Income <$125,000): https://on.ny.gov/2iyLbU6

I do not qualify for any of these (space permitting, you're still welcome here :)

Required

Which best describes the HIGHEST education level of your parent(s) / guardian(s)? *

Neither one attended high school

Some high school education for one or both of them

At least one has a high school degree

At least one attended some college

One has an associate's (typically 2 year) degree

One has a bachelor's (typically 4 years) degree

One has a bachelor's degree AND the other attended some college

Both have bachelor's degrees

One has a bachelor's degree; one has a master's degree or higher

One parent has a master's degree or higher

Both parents have master's degrees or higher

Family's Primary Vehicle (Year, Make, Model. Ex: "2016 Honda CRV"). Write "NONE" if your family owns no automobiles. *

How can you access the Internet at home (check ALL which apply): *

Cell Phone

Ipad or other tablet device

Laptop computer

Desktop computer

I cannot access the internet at home

Required

"I certify that all of the above answers are true, to the best of my knowledge. If attending in-person class, I agree not to hold Covenant Church PCA (or any of its members) responsible for any potential COVID-19 related incidents which could impact me directly or indirectly. " *

Yes, I agree

No, I disagree

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