UPRISE 2019 Registration Form
UPRISE 2K19
Email address *
First Name *
Your answer
Last Name *
Your answer
You are attending UPRISE as a *
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What city do you live in? *
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What is your Zip Code? *
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Phone Number
Your answer
Current School/College or School/College that you graduated from with year of graduation *
Your answer
Current Grade or Highest Education Level (if graduated) *
Ethnicity *
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How did you hear about UPRISE? *
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What are three things you feel would most help support you, your child, or students in education?
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