Disrupt Harlem Code Squad Interest Application
Welcome to the interest application for the Code Squad. Please fill this out by August 14, 2017.

Program Dates:
September 5th - December 14th : Coding & Entrepreneurship Training (MTW 10am-3pm)

If you have any questions please call 212-665-7010 or email harlembusinessalliance@gmail.com.

We'll reach out to you on AUGUST 16TH with next steps!

First Name
Your answer
Last Name
Your answer
Email
Your answer
Cell Phone Number
Your answer
Birthdate
MM
/
DD
/
YYYY
Current Address
Your answer
Current Zip Code
Your answer
Are you currently enrolled in school?
If you answered yes, which school?
Your answer
What is your highest level of education?
Have you completed any of the following workforce training programs?
Required
Do you have any experience with building web or mobile applications or sites?
If yes, please tell us how long, skill sets: languages/frameworks, and describe project(s)
Your answer
What types of skills are you interested in exploring?
Everything will NOT be covered in this program. Just the subjects with the '*'. Check off as many as you like.
At the end of the program, will you be interested in any of the following:
Please check all that apply.
Required
Will you be available to attend the program from September 5th - December 14th on weekdays from 10am-4pm?
If you answered no, please tell us your schedule conflict:
Your answer
What's your favorite website or mobile app? Why?
Your answer
How did you hear about this program?
Required
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