Higher Education Empowerment Program (HEEP) Summer Sessions 2022 Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

THANK YOU for your interest to register for our 2022 Summer Sessions! Sessions will be held on Saturday, June 18th. Each session will be 1 hour and 45 minutes long. Please be sure to choose your session preference.

Email *

Please choose your session preference *

Morning Session: Saturday, June 18, 2022 10am-11:45am

Afternoon Session: Saturday, June 18, 2022 12pm-1:45pm

1). Please indicate your legal first and last name and the name you wish to be called: *

2). Please indicate a number to contact you: *

3). Please indicate an address to receive information: *

4). Please indicate an emergency contact by indicating the person's name and phone number: *

5). Please indicate your educational background. *

some high school

GED/high school diploma

completed high school

some college

6). Please indicate your current work situation. *

unemployed

part-time

full-time

7). Our goal is to work with you to select the program that best fits you. Please indicate what industry/industries interest you. *

Arts, Multimedia, and Entertainment

Agriculture and Environmental Technology

Business, Entrepreneurship, and Management

Education (pre-k, K-12, or college and university)

Health Careers

Manufacturing and Construction

Public Safety

Real Estate

Retail, Hospitality, and Tourism

Science, Technology, Engineering, and Mathematics (STEM)

Required

8). Our goal is to support you in your educational and career journey. Please indicate which school interests you. *

2-year college

vocational/career college

4-year university

10). THE FOLLOWING QUESTION IS FOR OUR DATA TO HELP US KNOW MORE ABOUT OUR COHORT DEMOGRAPHICS. Please indicate your age group. *

18-44

45-75

11). THE FOLLOWING QUESTION IS FOR OUR DATA TO HELP US KNOW MORE ABOUT OUR COHORT DEMOGRAPHICS. Please indicate the ethnicity that you identify as. *

American Indian or Alaska Native-A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Asian-A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam

Black or African American– A person having origins in any of the Black racial groups of Africa.

Native Hawaiian or Other Pacific Islander– A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White or Caucasian– A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

12). THIS FOLLOWING QUESTION IS FOR OUR DATA TO HELP US IMPROVE OUR EDUCATION PROGRAM. Question: What barriers caused you not to pursue a college degree after high school or returning back to college? *

THANK YOU for completing our registration form. We will be in contact with you with more details.

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This form was created inside of Association of Yale Alumni.