Outreach/Workshop Registration Form
Complete this form to register for the 1890 Scholarship Awareness and Career Opportunities in Agriculture outreach/workshop.
Select one (Parent/Guardian or Student)
*
Parent/Guardian
Student
Name
*
First Name
Middle Initial
Last Name
E-mail
*
example@example.com
Mobile Number
*
School Currently Attending
*
If parent, enter NA
Current Grade
*
If parent, enter NA
Are you interested in attending an HBCU?
*
Please Select
YES
NO
Undecided
If parent, are you interested in your youth attending an HBCU?
Are you Familiar with the 1890 Scholarship Program?
*
Please Select
YES
NO
Submit
Should be Empty: