A Window Into the Future: Celebrate Black History Month with Mission Bit

Student

First Name (student)

Middle Initial

Last Name (student)

Preferred Name/Nickname

Phone (student)

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Email (student)

Please use non-school email account that you access most frequently.

Student's Date of Birth

Month/Day/Year

Do you live in San Francisco?

YesNo

What city do you live in?

Parent / Guardian

First Name (parent)

Last Name (parent)

Email (parent)

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Please verify that your parent has been notified that you are sharing their contact information with Mission Bit.

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What is your expected graduation year?

What high school do you attend/plan to attend?

Please Specify (School):

Which best describes your ethnicity?

Which best describes your race?

If other, please specify (race):

What gender do you identify as?

Please Specify (gender):

How did you hear about us?

I would like to receive informational and promotional emails from Mission Bit to both the student and parent in this form.