Sign-Up Form: Technology Training Program

How did you hear about the program?

Somerset Academy

North East Career and Technical Academy

Nevada Partners Staff

Previous Student

Social Media

Zip code *

Student Full Name *

Student Phone # *

Student Email *

Age This refers to the person who is participating. If you are applying on behalf of a minor, please add the minor's information

Gender

Male

Female

Non-binary

Prefer not to say

This refers to the person who is participating. If you are applying on behalf of a minor, please add the minor's information

Contact Information: Legal Parent/Guardian

This refers to the person who is participating. If you are applying on behalf of a minor, please add the minor's information

Legal Parent/Guardian's Full Name

Legal Parent/Guardian's Phone Number *

Legal Parent/Guardian's Email *

Participants would be required to attend once a week from 2:00 PM - 5:00 PM. Which day would you or the interested party be able to attend? *

Monday

Tuesday

Wednesday

Thursday

Friday

Would the interested party need transportation to The STEM Center? *

Yes

No

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