Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Birthdate ( MM/DD/YEAR) *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Ethnicity *Black/African AmericanCaucasianHispanicAsianOtherSex *MaleFemaleAre you a college student or from a robotics team? *YesNoWhich university or robotics team are you apart of? *List any food allergies / medical conditions *Do you like working with Youth? *YesNoSometimesIt is important to model a positive attitude toward working with youth. "It is easier to build strong children than to repair broken men." -Frederick DouglassEmergency Contact Person *FirstLastEmergency Contact Phone *Have you ever been convicted of a felony? *YesNoSkilled Trades / Educator Assignment: *STEM Teacher - help students build robots(STEM)Youth Project Assistant - Assist youth with STEM projectsCulinary Art Assistant-Assist youth with recipesSkilled Trades- ElectricalSkilled Trades- PlumbingSkilled Trades- CarpentryTeacher-Character Traits ClassClassroom Aid for Character TraitsKitchen Food or Snack ServerPhotographerFacilitate activties (Keep youth engaged)Select all that apply.STEM Coding Experience *Advanced (I know how to code)Intermediate (I have a basic knowledge of coding)Basic (I am willing to learn basic coding to help the kids)I have no coding experienceHave you ever done any volunteer work before? If yes, tell us about your experience *Do you have any particular skills or qualities that your could use in your volunteer work? *How did you hear about our program? *Week 1- I can volunteer on: *MondayTuesdayWednesdayThursdayFridayUnavailable this weekWeek 2- I can volunteer on: *MondayTuesdayWednesdayThursdayFridayUnavailable this weekWeek 3- I can volunteer on: *MondayTuesdayWednesdayThursdayFridayUnavailable this weekWeek 4- I can volunteer on: *MondayTuesdayWednesdayThursdayFridayUnavailable this weekPlease select your T-shirt size ? *Small AdultMedium AdultLarge Adult1X Large2X Large3X Large4X Large5X LargeDriver's License Number (Needed for Background check) *Expiration Date *Submit
