Name *

Your first and last name must match the names used on your Uplift application.

First Name

Last Name

Phone *

If you do not have a phone number, you can enter the number of a parent or guardian, or you can enter 555-555-5555.

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To successfully complete Uplift and be eligible for any stipends, certificates, or prizes, participants must attend all 4 days of the training. *

I can attend each of the four days, for the full 4.5 hours.

I am unsure if I can attend fully and wish to speak to an Uplift Staff Member

For the safety of our Uplift participants, we have a mandatory requirement that all participants must connect to Zoom with their cameras and microphones.

I will use my camera and microphone at all times during the Uplift Event

I am unsure if my equipment will allow me to use my camera or microphone during the event.

I have another question or concern about using my camera or microphone during the event.

Please read our Consent Form and acknowlege below *

I am the legal parent or guardian of this attendee

I am an adult (18 years and up) and signing this release on my behalf

What is your gender identity? *

Female

Male

Non-binary

Other

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 race/ethnic identity? (Select all that apply) *

Asian or Asian-American

Black or African-American

Hispanic or Latinx

Indigenous (Native American or Alaska Native)

Middle Eastern

Mixed Race

Native Hawaiian or Pacific Islander

White or Caucasian

Prefer not to say

Other

Do you identify as a person with a disability? *

If yes, you must complete the remaining questions. If no, you can submit your check-in form.

Yes, I identify as a person with a disability

No, I do not identify as a person with a disability

If you answered yes to the disability question above, which of these statements best describes you?

I may need accommodations to participate fully in the Uplift training. Please contact me.

I do not require any accommodations to participate fully in the Uplift training