ctsRegistration.ContentModels.StudentRegistrationModel ctsRegistration.ContentModels.StudentRegistrationModel

STUDENT REGISTRATION

Tell us about yourself

Please fill out the following form to register for our junior high and high school Code to Success summer program! Make sure all information is accurate with no typos.

Summer Program Dates: June 13th - July 15th, 2022

Which program are you registering for?

Which course would you like to participate in?

Student First Name

Student Last Name

Student Phone

Student Email

Please verify the student email listed above is the student's personal email. This email will be used daily for the student to access the Code to Success curriculum. Yes, it is the student's personal email - it is not a parent email or a school email. Code to Success sends out emails and creates curriculum profiles with the STUDENT's email.

Street Address

City

State

Zip Code

Country

Parent/Guardian Full Name

Parent/Guardian Email

Parent/Guardian Phone

By giving a parent/guardian phone number, you are agreeing to receive reminders and important program information via text and/or calls. I understand I may receive text or call communications

Coding Experience

What grade are you currently in?

What school district are you in?

What junior high or high school are you attending?

Would you like to register for the On-Campus program or the Online option?

What device(s) can you access to complete the coding course?

PC - desktop or laptop

MAC - desktop or laptop

Chromebook

Please select your preferred campus

Have you participated in a Code to Success program before?

How did you hear about Code to Success?

Please check if you have read and agree to the Code of Conduct Code of Conduct Yes, I have read and agree to the Code of Coduct

Shirt Size (adult sizes - not fitted)

Gender Identification

Please select a category that best represents you

Do you qualify for free or reduced lunch?