Application: Protest and Print @ Girls Garage
Please complete the following application for the Spring 2019 Protest and Print class at Girls Garage. This course will take place over 8 Wednesdays, after-school from 4:30-6:00pm, January 23 - March 13.

Applications will be reviewed and accepted on a rolling basis until the course is fully enrolled at a total of 12 girls (so please apply early!). Please note that while this class is open to all, we will take individual applicant data and responses into account in order to bring together a diverse and enthusiastic group of girls. For questions regarding the application or class, please email Emily Pilloton, Director, at emily@girlsgarage.org.

Applicant first name *
Your answer
Applicant last name *
Your answer
Applicant date of birth (must be 13-17 years old by first day of program) *
MM
/
DD
/
YYYY
Applicant email address (if you have one)
Your answer
Applicant cell phone number (if you have one)
Your answer
Street/mailing address *
Your answer
City, State, Zip Code *
Your answer
What grade are you in? *
What school do you go to? *
Your answer
Which race(s) do you identify as? Please select as many as apply.
Why are you interested in taking this class? (3-4 sentences) *
Your answer
You will be designing and making protest posters in this class. What current issues in your life or the broader world are you personally interested in, curious about, angry about, or worried about that you might like to explore through the art of printmaking? Please share why these issues are personal to you, if you feel comfortable. *
Your answer
Do you have any previous experience printmaking, screen-printing, or with other graphic arts? If so, what? (No experience is necessary, just wondering!) *
Your answer
Do you have any allergies? If none, please say "NONE" *
Your answer
Do you have any dietary restrictions? If none, please say "NONE" *
Your answer
Do you have any medical conditions, take any medication (if so, what and what dosage), or have any other limitations you'd like us to be aware of? If none, please say "NONE" *
Your answer
Name and contact info for your doctor (optional):
Your answer
Primary parent/guardian first name: *
Your answer
Primary parent/guardian last name: *
Your answer
Primary parent/guardian email address: *
Your answer
Primary parent/guardian phone number: *
Your answer
Primary parent occupation *
Your answer
What languages are spoken at home?
Your answer
Highest level of parent(s) education
What is your approximate annual family/household?
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Project H Design. Report Abuse - Terms of Service