SoLA Robotics Program Interest

Name* This field is required.

First Name

Last Name

Role/Title* This field is required.

N/A if not applicable.

Company/Organization/School* This field is required.What is your affiliation?

N/A if not applicable.

Email* This field is required.

example@example.com

Phone Number* This field is required.

Please enter a valid phone number.

Website* This field is required.

Business AddressIf you are interested in bringing SoLA Robotics to your area, please provide the appropriate business address.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

How did you hear about South LA Robotics?* This field is required.

SoLA Robotics Staff

Newspaper/TV/Radio

Word of Mouth

Website

Social Media

Google Search

Other

Are you interested in bringing robotics to your school, organization, or event?* This field is required.

School

Organization

Event

Something Else

What kind of collaboration did you have in mind?* This field is required.

Upload Your Organization/School's Logo* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

What kind of program(s) are you MOST interested in having us provide?* This field is required.

Adulting Training/Education (Professional Development)

Coding (Programming Virtual Robotics on Computers)

Hands-on (Building/Programming Robots)

Informational (Interactive Booth)

Other

What program duration would you be interested in?* This field is required.(for example, day robotics experience, once a week or more, semester-long, year-long program, summer program)

Weekly

School Semester

One-off Robotics Experience

School Year

Summer Program

What days are you interested in SoLA Robotics programming?* This field is required.

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time of day are you interested in?* This field is required.(For example: Mornings during school, Wednesdays after school, Weekend, etc)

What age(s) are the students you are serving?* This field is required.

Elementary

Kids (5-11 yrs)

Youth (12-18 yrs)

Young Adults (19-24 yrs)

Adults

Older Adults

Select ALL that applies to your student population.* This field is required.

Charter School

Educators (Training)

Elementary School

General Public Events (Families)

High School

Homeschool (Grades 7-12)

Homeschool (Grades K-6)

Independent School

LAUSD School

Middle School

Public

Other

What is your budget for programming?* This field is required.

What is the funding source?* This field is required.ie: BSAP

Name of your event* This field is required.

Day and time of the event* This field is required.

Tell us about your event.* This field is required.

Event location and address* This field is required.

Participation Fee? List total amount along with how and when to submit payment.

Insurance Required? List any requirements along with how and when to submit documentation.

Describe event parking* This field is required.

Load In/Load Out Time* This field is required.

Describe how you would like SoLA Robotics to participate.* This field is required.

Estimated Attendee/Guest Count* This field is required.

Upload an Event Flyer

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

What else do you want us to know? * This field is required.This can help us determine the best robotics/coding curriculum for your needs.

Are you interested in volunteering with SoLA Robotics?

YESNO

SoLA Robotics Program Interest