One Step At A Time 2020 Application

1

Do you identify as female?* This field is required.

YESNO

2

Have you just completed your 6th, 7th, or 8th grade year of school?* This field is required.

YESNO

3

Are you able to attend every day of the program? * This field is required.Our program runs every weekday from August 3rd - 14th from 9AM - 1PM PST. You will have weekends free.

YESNO

4

Do you have access to a laptop or desktop computer device at home?* This field is required.

YESNO

5

Does your have a device with a functioning camera?* This field is required.

YESNO

6

Does your device have a functioning microphone?* This field is required.

YESNO

7

Do you have reliable internet access?* This field is required.

YESNO

8

Let's get started. What's your name?* This field is required.

First Name

Last Name

9

What is your e-mail?* This field is required.If you need to create an e-mail, common e-mail providers are Gmail and Yahoo Mail. Please make sure this is a working e-mail, as your acceptance letter will be sent to this e-mail.

example@example.com

10

What is your phone number?* This field is required.

Area Code

Phone Number

11

What is your birthdate?* This field is required.

Date

12

What is your parent/guardian's name?* This field is required.

First Name

Last Name

13

What is the relationship to the student?* This field is required.

14

What is your parent/guardian's e-mail?* This field is required.

example@example.com

15

What is your parent/guardian's phone number?* This field is required.

Area Code

Phone Number

17

How do you think One Step At A Time will help you?* This field is required.Let us know why you want to join our program and what you're looking to get out of One Step At A Time.

18

Is there anything else you want to let us know? Feel free to type it below.If someone referred you to the program, please type their name below.

19

Unfortunately, you are not eligible for our program based on your response. We thank you for your interest in One Step At A Time.