Instruments for Success Registration
First Name *
Your answer
Last Name *
Your answer
Email address *
Your answer
Cell Phone *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parents' Names *
Your answer
Parents' Email Address *
Your answer
Parents' Cell Phone (or Home Phone) *
Your answer
School *
Your answer
Grade in School *
Philadelphia School District Student ID Number
Your answer
How would you describe your gender? *
How would you describe your race/ethnicity? *
Are you a PMAY fellow? *
In order to receive the $200 stipend, I understand and agree with the absence policy defined here. The following are allowed: 1 unexcused absence and 2 excused absences. Excused absences must be sent to sloewy@project440.org at least 1 week prior to the missed class. In the case of an emergency, a shorter notice time will be accepted if the email or note comes from your parent. If sick, a note in writing from your parent should be handed to the Teaching Artist the week following the missed class. *
In order to be eligible for the stipend, I understand in addition to attending 7 of the 11 sessions, I must also complete the weekly reflection surveys emailed to me after the class. The surveys should be completed by Friday of each week. *
I understand that class runs weekly on Wednesdays from 4-6PM at 1700 S. Broad at the South Philadelphia Library. *
I understand that I am a guest in the space at the South Philadelphia Library, and will treat the rooms with respect. This includes cleaning up after eating, keeping the equipment safe, and keeping all belongings nearby and out of the way. *
Thank you, and congrats on signing up! It's going to be a great semester of Instruments for Success!
Questions? Email Program Director Susanna Loewy at sloewy@project440.org.
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