First name *

Last name *

Email address (for more info and a reminder): *

Cell phone number with area code:

Are you very familiar and good with computers and the internet, can you type 30+ WPM, and do you know how to use a mouse/trackpad, browsers, and email? *

Do you agree to the following media release? Photographs, pictures, writing, assignments, recordings, likenesses, slides, movies, video, or other media coverage of my activities created or performed by me may be made in connection with my participation in Techtonica’s programs without compensation from Techtonica/Social Good Fund, activity-specific staff, its auxiliary organizations, and the officers, directors, employees, and agents of each of them. I also consent for the company to take, use, reuse, publish and republish any and all media coverage depicting the same (including compilations or other derivative works) both during and after involvement with the organization for any legal purpose and release Techtonica/Social Good Fund from all liability in connection with such activities. *

Which do you identify with the most? *

Which best describes your gender identity? *

Which pronouns should we use for you? *

Do you have a laptop you can bring to a workshop? *

Where do you live? *

Are you currently employed full time? *

Are your family/household income and net worth under $50,000? *

Why are you interested in learning technical skills like coding? *

Which days and times are the best for you to attend workshops? *

Are you interested in Techtonica's full-time technical apprenticeship? *