ChickTech Atlanta Nomination Form
Do you work in an Atlanta area school and want to nominate a girl for our program? Please complete this form and we'll be in touch shortly. For more information, visit our website at
Nominator Name *
Nominator Email *
Student's First and Last Name *
Student's Grade as of November 2017 *
Student's High School *
Student's Email *
How do you know this student? *
Do you think that this student would benefit from the program? *
Explain: *
Does this student show an interest in technology or a tech career? *
Is this student on free or reduced lunch? *
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