Instruments for Success Detailed Registration
Welcome to Instruments for Success! Please complete the following form to enroll in the course.
First Name *
Last Name *
Email *
Cell Phone *
Address *
Parents' Names *
Parents' Email *
Parents' Cell Phone (or House Phone) *
School *
Year in School *
Philadelphia School District Student ID Number
Gender Identification
Race/Ethnicity Identification
Are you a PMAY Fellow? *
In order to receive the $200 stipend, I understand and agree with the absence policy defined here. The following are allowed: 1 unexcused absence and 2 excused absences. Excused absences must be sent to sloewy@project440.org at least 1 week prior to the missed class. In the case of an emergency, a shorter notice time will be accepted if the email or note comes from your parent. If sick, a note in writing from your parent should be handed to the Teaching Artist the week following the missed class. *
In order to be eligible for the stipend, I understand in addition to attending 7 of the 11 sessions, I must also complete the weekly reflection surveys emailed to me after the class. The surveys should be completed by Friday of each week. *
I understand that class runs weekly on Wednesdays from 4-6PM at 440 N. Broad in the PSTV Station. *
I understand that I am a guest in the space at the PSTV Station, and will treat the rooms with respect. This includes cleaning up after eating, keeping the equipment safe, and keeping all belongings nearby and out of the way. *
I understand that I must return the PSTV parental permission forms I receive. *
Thank you!!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms