Name *

Your first and last name must match the names used on your Uplift application.

First Name

Last Name

Phone *

If you do not have a phone number, you can enter the number of a parent or guardian, or you can enter 555-555-5555.

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To successfully complete Uplift and be eligible for any stipends, certificates, or prizes, participants must attend all 4 days of the training. *

I can attend each of the four days, for the full 4.5 hours.

I am unsure if I can attend fully and wish to speak to an Uplift Staff Member

For the safety of our Uplift participants, we have a mandatory requirement that all participants must connect to Zoom with their cameras and microphones. *

I will use my camera and microphone at all times during the Uplift Event

I am unsure if my equipment will allow me to use my camera or microphone during the event.

I have another question or concern about using my camera or microphone during the event.

Please read our Consent Form and acknowlege below *

I am the legal parent or guardian of this attendee

I am an adult (18 years and up) and signing this release on my behalf

What is your gender identity? *

Female

Male

Non-binary

Other

Do you identify as a member of the LGBTQ+ community? *

Yes, I identify as part of the LGBTQ+ community

No, I do not identify as part of the LGBTQ+ community

Prefer not to say

I'm not sure

What is your race/ethnic identity? (Select all that apply) *

Asian or Asian-American

Native Hawaiian or Pacific Islander

Black or African-American

Hispanic or Latinx

Indigenous (Native American or Alaska Native)

Middle Eastern

White or Caucasian

Prefer not to say

Other

Do you identify as a person with a disability? *

If yes, you must complete the remaining questions. If no, you can submit your check-in form.

Yes, I identify as a person with a disability

No, I do not identify as a persona with a disability

If you answered yes to the disability question above, which of these statements best describes you?

I need special accommodations to participate fully in the Uplift training

I do not require any special accommodations to participate fully in the Uplift training

I am unsure if I require any special accommodations and wish to speak with an Uplift staff member