UA-2018 STEM LEADERSHIP FOR GIRLS REGISTRATION FORM
This one-day conference for girls in grades 9 - 12 will be held on February 10, 2018 at University of Arkansas.
First Name *
Your answer
Last Name *
Your answer
Name you would like on your NAME TAG *
Your answer
Student or parent email address *
Your answer
Student complete home address *
Please include your street address, city, state and zip code.
Your answer
Parent phone number in case of emergency *
Your answer
Student cell phone number *
Your answer
What school do you presently attend? *
Your answer
What school district do you attend? *
Your answer
Student ID number from the school (for STEM data collection) *
If you do not have a student ID number, please type in your birthday. example: (month/day/year 08/14/1995)
Your answer
Choose your grade level for this school year *
Required
At this time, what career are you most interested in pursuing? *
Your answer
Choose the location and the date of the STEM Leadership for Girls workshop you plan to attend. *
Required
Demographics- Please check your ethnicity *
Required
Check which mathematics courses you have competed or are in enrolled in now. *
Check all that apply.
Required
Check which science courses you have completed or are in enrolled in now. *
Check all that apply.
Required
Do you plan to enroll in a computer science course next semester? *
Required
What are your expectations for the STEM Leadership for Girls workshop? *
Your answer
Chaperone's Name and Contact Information (If applicable)
Your answer
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