DREAMER INTEREST FORM
Looking to get involved?
Tell us about yourself!
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First
please enter a valid first name
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Last
please enter a valid last name
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Email
please enter a valid email
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Phone Number
please enter a valid phone number
College of Interest
- Dream big!
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High School Graduation Year
select
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
please select a graduation year
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Date of Birth
Youth members must be ages 10-19
please enter a valid date of birth
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Gender
select
Male
Female
Other
Prefer Not to Say
please select a gender
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Ethnicity
select
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latino/a/x
Middle Eastern or MENA
Native Hawaiian or Other Pacific Islander
Southeast Asian
White non-Hispanic
Bi/Multiracial
Other
Prefer Not to Say
please select an ethnicity
Ethnicity Other: please explain
What are some of your favorite foods and snacks?
What are your dream careers and future goals?
Parent/Guardian Information
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Guardian First
please enter a valid guardian first name
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Guardian Last
please enter a valid guardian last name
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Guardian Relationship
please enter a valid guardian relationship
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Guardian Email
please enter a valid guardian email
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Guardian Phone Number
please enter a valid guardian phone
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Street Address
please enter a valid address
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Zip Code
please enter a valid zip code
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City
please enter a valid city
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Highest Education
select
High School or Equivalent
Some College
Associate Degree
Bachelor Degree
Master Degree
Doctorate Degree
Prefer Not to Say
please select highest education
Does the student have any allergies?
Yes
No
Please list student's allergies:
Will the student have reliable transportation for mandated events?
Yes
No
Are you willing to participate in family schedule events?
Yes
No
Do you see your family relocating in the next four years?
Yes
No
SUBMIT