Summer 2024 Tech Start Program Application

Student

First Name (student)

Middle Initial

Last Name (student)

Preferred Name/Nickname

Phone (student)

Numbers only.

Email (student)

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

Student's Date of Birth

MM/DD/YYYY

What is your zip code?

Parent / Guardian

First Name (parent)

Last Name (parent)

Phone (parent)

Numbers only.

Email (parent)

This email must be different from the student's email.

What is your high school graduation year?

What high school did/do you to attend?

Please Specify (School):

If other, please specify (race or ethnicity):

What gender do you identify as?

Please Specify (gender):

Please write a 3-5 sentence bio that will be shared with mentors for you to be matched, if you are accepted. Note: Mentor bios will be shared with you for you to rank who you want to be matched with.

Which workshop are you most excited about taking?
Note: Refer to the website for the program details: https://missionbit.org/career-prep

How did you hear about us?

Please specify:

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

Contact Information