The Changemaker Project Student Registration and Pre-Survey 2020
This form encompasses the registration and pre-survey and is required for all students to complete before beginning the online course. These questions help us to measure our impact; thank you for taking the time to answer them thoroughly!
First Name *
Your answer
Last Name *
Your answer
School Email (Please check for typos!) *
Your answer
Alternate Email
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Are you in high school or college? *
Preferred Pronouns *
How would you describe yourself? *
Required
How did you hear about this program? *
If a specific person referred you to the program, please enter their name here:
Your answer
School Name *
Your answer
School Address (Street) *
Your answer
School Address (City) *
Your answer
School Address (State) *
Your answer
School Address (Zip) *
Your answer
School Address (Country) *
Your answer
Have you formed a team yet? *
Team Advisor Name *
Your answer
Team Advisor Email *
Your answer
What is your advisor's relationship to the team? *
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