Code Chica Certification Program- Student Form
Thank you for your consideration in signing up for our Code Chica Certification Program! Please fill out this form if you are interested in signing up to be a part of this free program.

While enrolled in the Code Chica Certification Program, students will:
- Be placed in cohort groups of 10 students for an 8-week long class
- Class meets on Saturdays from 10am-2pm at Latinitas' office, 1023 Springdale Rd. Building 9E
- This program is available to high school girls between 8th and 12th grade
- Students may not miss more than one class for the duration of the program.

Students will work together with instructors and guest speakers that currently work in computer science, engineering, technology development, and more, and will learn fundamentals of Javascript and website building, along with higher order functions and more, to create their own website!

This program is FREE, and upon completion of the program, students will receive a $75 stipend and a certificate outlining their accomplishments.

Thank you again!

Student Name *
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Student Age *
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Student Email *
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Parent Name *
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Parent Email *
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School *
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Would you like to sign up for Latinitas' newsletter? If so, what email works best?
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How did you hear about this program? *
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Do you require any accessibility related needs throughout the duration of the program? If so, how can we help ensure your needs are met? *
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What cohort date(s) would you be available? You must be available during ALL of these dates to sign up for a cohort. *
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If the cohort group you selected is filled, what other cohort groups would you be interested in? Please select as many as you'd like. *
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I understand that, in order to receive the stipend and certification, I must attend all cohort meetings with the exception of one excused absence. *
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I understand that if I commit to this program, my full participation in individual and group activities is expected and valued. *
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