You can always press Enter⏎ to continue
Pave The Path 2024-2025 Registration Form
Please complete the following information.
START
1
Student Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Student Email
*
This field is required.
Personal email preferred. School email is okay if you don't have a personal email.
example@example.com
Previous
Next
Submit
Press
Enter
3
Student Phone Number
*
This field is required.
Please add your parent's phone number, if you don't have one.
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
4
Address
*
This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
5
School Name
*
This field is required.
Previous
Next
Submit
Press
Enter
6
Grade Level
*
This field is required.
9th grade
10th grade
11th grade
12th grade
Post-high school (trades/employed)
Post High School (higher education - college, etc)
Post High School (military)
Previous
Next
Submit
Press
Enter
7
What are your career aspirations?
Please choose ONE!
Please Select
Architecture & Engineering (architect, engineer (any), landscape, etc.)
Arts, Culture & Entertainment (animator, film, graphic design, photography, music, fashion design)
Business, Management & Administration (HR, accountant, entrepreneur, real estate, marketing, etc.)
Communications (journalist, copy writer, PR, event planner, social media manager, brand manager, etc.)
Community & Social Services (counselor, social worker, etc.)
Education (teacher, administration, professor, librarian, superintendent, etc.)
Farming, Fishing & Forestry (agriculture, conservation, ranger, forestry, fisher, etc.)
Government (politics, firefighter, police officer, etc.)
Health & Medicine (doctor, anesthesiologist, nurse, veterinarian, physical therapy, etc.)
Law & Public Policy (lawyer, paralegal, judge, public administration, etc.)
Military (branches, national guard, etc.)
Sales (sales associate, account management, pharmaceutical sales, insurance agent, etc.)
Science & Technology (archeology, software engineer, lab tech, biology, physics, etc.)
Sports (professional athlete, trainer, agent, coach, etc.)
Trades: Installation, Repair & Maintenance (auto mechanic, plumber, electrician, etc.)
Please Select
Please Select
Architecture & Engineering (architect, engineer (any), landscape, etc.)
Arts, Culture & Entertainment (animator, film, graphic design, photography, music, fashion design)
Business, Management & Administration (HR, accountant, entrepreneur, real estate, marketing, etc.)
Communications (journalist, copy writer, PR, event planner, social media manager, brand manager, etc.)
Community & Social Services (counselor, social worker, etc.)
Education (teacher, administration, professor, librarian, superintendent, etc.)
Farming, Fishing & Forestry (agriculture, conservation, ranger, forestry, fisher, etc.)
Government (politics, firefighter, police officer, etc.)
Health & Medicine (doctor, anesthesiologist, nurse, veterinarian, physical therapy, etc.)
Law & Public Policy (lawyer, paralegal, judge, public administration, etc.)
Military (branches, national guard, etc.)
Sales (sales associate, account management, pharmaceutical sales, insurance agent, etc.)
Science & Technology (archeology, software engineer, lab tech, biology, physics, etc.)
Sports (professional athlete, trainer, agent, coach, etc.)
Trades: Installation, Repair & Maintenance (auto mechanic, plumber, electrician, etc.)
Previous
Next
Submit
Press
Enter
8
What is your greatest STRENGTH?
*
This field is required.
One word answer.
Previous
Next
Submit
Press
Enter
9
What is your personal BRAND?
*
This field is required.
"I don't know" is a totally acceptable answer!
Previous
Next
Submit
Press
Enter
10
T-Shirt Size
*
This field is required.
S
M
L
XL
2XL
3XL
Previous
Next
Submit
Press
Enter
11
Date of Birth
*
This field is required.
Previous
Next
Submit
Press
Enter
12
Gender
*
This field is required.
For demographic purposes only.
Female (she/her)
Non-binary (they/them)
Male (he/him)
Other
Previous
Next
Submit
Press
Enter
13
Race/Ethnicity
*
This field is required.
For demographic purposes only.
American Indian / Alaska Native
Asian
Black / African American
Hispanic / Latino
Native Hawaiian / Other Pacific Islander
White / Caucasian
Mixed / Multiracial
Other
Previous
Next
Submit
Press
Enter
14
Annual Household Income
*
This field is required.
CONFIDENTIAL - For grant purposes only.
Less than $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 or more
Previous
Next
Submit
Press
Enter
15
Does the student have any intellectual, developmental, or physical disability?
*
This field is required.
CONFIDENTIAL - For grant purposes only.
Yes
No
Previous
Next
Submit
Press
Enter
16
If Yes, please specify.
CONFIDENTIAL - For grant purposes and/or any necessary accommodations.
Previous
Next
Submit
Press
Enter
17
Parent/Guardian Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
18
Parent/Guardian Phone Number
*
This field is required.
NOTE: Parent/guardian will be considered Emergency Contact by default. If you would like to add an additional emergency contact, please list name, phone number, and relation to the individual in the Message section of this form.
Area Code
Phone Number
Previous
Next
Submit
Press
Enter
19
Parent/Guardian Email
*
This field is required.
Previous
Next
Submit
Press
Enter
20
How did you hear about Pave The Path?
*
This field is required.
Jeff Roberts (Program Director)
Social Media
A Friend or Family Member
School or Teacher
Other
Previous
Next
Submit
Press
Enter
21
Message
OPTIONAL: Please share any additional thoughts or questions you may have.
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
21
See All
Go Back
Submit
