Shift_Up Membership Application
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Last name *
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I am applying for the following track: *
What's one thing you're curious about? How have you pursued that interest? *
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Describe a time you made a commitment to achieve a difficult goal for yourself. What were the challenges you faced, and how did you overcome them? *
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What do you want to get out of this program, and why? *
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Phone number *
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Email address *
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Home address (street address, city, zip code) *
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Birthday *
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Gender *
Racial/Ethnic Background *
Level of coding experience PRIOR to Shift_Up workshops *
Formal education level *
Did a current Shift_Up member refer you to us? If so, please list their name here:
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Anything else we should know about you?
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