EmailMeForm
Demographic Information 2024
The information provided in this form is anonymous and completely optional. The sole purpose of this form is to provide context to our donors, and partners, and for future grants. Your privacy is our top priority, and we appreciate your willingness to share your information with us.
Which program you are filling out this form on behalf of
*
HBCU Tour
HBCU Virtual Tour
Parent/Guardian Training Workshops
Prep for Success Workshops (A.I. , Cyber Security, Medical Careers etc.)
select all the apply
How old are you?
*
Do you have any partner affiliation
Alameda County Probation Department Juvenile Services Division Delinquency Prevention Network (DPN) Agencies
BAYCIPP-Children of Incarcerated Parents
Berkeley Youth Alternatives
City of Fremont Youth & Family Services
City of Hayward Youth & Family Services
Evergreen Community College-Santa Clara
Fresh Lives for Youth -F.L.Y.
Love Never Fails
None
Points of Light
Project Eden- Hayward
Select schools in Alameda & Contra Costa County
Acts Full Gospel
Palma Ceia Baptist Church
Santa Clara County Black Educators Association
South Bay Community Church
Other
What grade are you in?
*
Sixth (6th)
Seventh (7th)
Eighth (8th)
Freshman (9th)
Sophomore (10th)
Junior (11th)
Senior (12th)
Completed High School/GED
Graduated from College/University
Postgraduate/Advanced Studies
Other
Which best describes your race/ethnicity? Please check all that apply:
*
American Indian or Alaskan Native
Asian American
Black/African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
Prefer not to respond
Other was selected, please specify below:
Appropriate Annual Income
*
$25,000 - $49,999
$50,000- $74,999
$75,000- $99,999
$100,000- $124,999
$125,000- $149,999
Over $150,000
Parent/Guardian #1 Highest level of education:
*
High school diploma
Some college
College degree
Some graduate school
Graduate degree
Not Applicable
Prefer not to respond
Parent/Guardian #2 Highest level of education:
*
High school diploma
Some college
College degree
Some graduate school
Graduate degree
Not Applicable
Prefer not to respond
