Thank you for your interest in our upcoming workshop! The Inspiredu Staff looks forward to working with you.  For our Family Learning Workshop, an adult and student must attend together. We ask that the registration form be completed by the adult who is planning to attend the workshop.

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* 1. Last Name

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* 2. First Name

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* 3. Email Address 

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* 4. Phone Number - Cell is Preferred.  

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* 5. What year were you born?

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* 6. Current age range?

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* 7. Gender

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* 8. Language Spoken Most Often at Home

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* 9. Ethnicity/Race

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* 10. County of Residence

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* 11. ZIP Code of Residence

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* 12. Highest Level of Formal Education

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* 13. Are you or any other adult in your Household currently enrolled in a formal program to further your own education?  (example:  GED, certification program, college classes, job training, etc)

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* 14. Annual Household Income (combined total for your household)

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* 15. How many Adults are in your household?

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* 16. Are you the parent/guardian of any children that are under 18?

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* 17. How many children (ages 0-17) live in your household?

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* 18. What is the first and last name of the child who will attend the workshop with you?

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* 19. What school does this child attend?

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* 20. What is the grade level of this child?

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* 21. How many computers (desktop, laptop, or tablet) are currently in your home? Please include both those you own and those that may be on loan to you from a school and/or organization.

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* 22. Of the computers in your home, how many do you/your family own?

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* 23. What type of Internet access do you currently have in your home?

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* 24. At times, our workshops include refreshments for learners. Do you/your child have any dietary preferences?

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* 25. Our goal is for all learners to be comfortable when attending our workshops. Do you/your child have any needs that we may be able to accommodate? (Example – mobility, vision, hearing, etc)

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