Name *

First Name

Last Name

Phone *

We only text occasionally with important updates. You can enter a parent or guardian's phone here as well if you don't have your own cell

(###)

###

####

Do you identify as a person with a disability? *

Yes

No

Maybe? I'm not sure

Gender: How do you identify? *

Male

Female

Non-Binary

Do you identify as a member of the LGBTQ+ community? *

Yes, I identify as part of the LGBTQ+ community

No, I do not identify as part of the LGBTQ+ community

Prefer not to say

I'm not sure

What is your racial or ethnic identity? (Select all that apply.) *

Asian or Asian-American

Black or African-American

Hispanic/Latinx

Middle Eastern

Indigenous (Native American or Alaska Native)

Mixed Race

Native Hawaiian or Pacific Islander

White or Caucasian