Student Application Student Application Application for students interested in joining one of MINDDRIVE's after-school programs. GENERAL INFORMATION Student First Name * Student Last Name * Student Email * Student Phone (If Applicable) * Gender * Date of Birth * Address * City * State * Zip Code * School * Grade * T-Shirt Size Program Interested In: * Welding Art Studio Session 1 Monday 5-6:30pm Welding Art Studio Session 2 Monday 7-8:30pm NRL Battlebots Team Purple (Grade 5-8) - Tuesday 5-6:30pm NRL Battlebots Team Black (Grade 9-12) - Tuesday 7-8:30pm Electric Vehicle Design Studio - Wednesday 5-8:30pm Drone FPV Racing - Thursday 5-6:30pm eSports Team Purple (Grades 5-8) - Friday 5-6:30pm eSports Team Black (Grades 9-12) - Friday 7-8:30pm Parent/Guardian First Name * Parent/Guardian Last Name * Parent/Guardian Email * Parent/Guardian Phone (ex. 123-456-7890) * Additional Parent/Guardian First Name Additional Parent/Guardian Last Name Additional Parent/Guardian Email Additional Parent/Guardian Phone (ex. 123-456-7890) How will the student get to and from MINDDRIVE? DEMOGRAPHIC INFORMATION - All students regardless of gender, race, ethnicity, or functional ability are welcome and encouraged to apply. This information is not used to determine eligibility. It is for reporting purposes only. Which of the following best represents your ethnic heritage? * Black/Afro-Caribbean/African-American Caucasian/Euro-American East Asian/Asian-American Latinx/Hispanic-American Middle-Eastern/Arab-American Native American/Alaskan Native South Asian/Indian-American Other ____________________________________________ Is this applicant eligible for free or reduced lunch? * Yes No Not Sure Does the applicant have an Individual Education Plan (IEP)? * Yes No Not Sure HEALTH INFORMATION - Let us know any information that will allow us to better help and/or accommodate the student. Does the student require any special accommodations for reading, testing, classroom work, or physical work? * Yes No If Yes, please describe: Please list any Allergies or Dietary Restrictions: Captcha If you are human, leave this field blank. Submit
