JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Free Web Dev Bootcamp (5 Weeks)
Sign in to Google
to save your progress.
Learn more
* Required
Why are you interested in learning web development?
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Were you affected by COVID-19?
*
Yes
No
If yes, please let me know how?
Your answer
About you
These questions are my way of understanding who I am serving in the classroom. None of this will ever be published or shared in a way that it can be tied back to you.
Gender
*
Man
Woman
TransMan
TransWoman
Genderqueer/Gender nonconforming
Two Spirit
Decline to answer
Other:
With which race / ethnicity do you most identify?
*
Black or African American
Hispanic or LatinX
Middle Eastern or North African
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
White
2 races/ethnicities or more
Other:
What's your highest level of education?
*
I'm still in high school
GED, HiSet
High School Diploma
Some College
College Degree
Masters
Professional Degree (PhD, MD, ect)
How did you hear about the class?
*
Twitter
Reddit
My Blog / Newsletter
Friend or Family Member
Search Engine
Other:
Do you require any accommodations in the classroom?
Yes
No
Clear selection
If yes, please let me know how I can best help you in classroom.
Your answer
Anything else I should know about you?
Your answer
Since this class will be conducted virtually and recorded, I need permission to record your voice and possible image. By selecting yes, you agree to be recorded in the context of this class.
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
