Register for the Next Tech Girl Superhero 2018 Student Ambassador Program
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First Name *
Your answer
Last Name *
Your answer
Your email address *
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Your mobile phone number *
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Street Address *
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City or Town *
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State *
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Country *
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School Name when you were in Search for the Next Tech Girl Superhero Competition *
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Current School Name (if different)
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Current Grade Level *
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Current Age *
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Parent/Guardian First Name
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Parent/Guardian Last Name *
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Parent/Guardian Email Address *
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Parent/Guardian Phone *
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What was your team name and which year did you participate? *
Your answer
If selected, will you be able to attend a virtual training for Student Ambassadors in September 2017 and commit to monthly online meetings between September 2017 - August 2018? *
Please provide an email address and a phone number for your mentor or another adult who would be able to serve as a reference. *
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