After School Student Interest Survey
Please fill out your interests in various S.T.E.A.M. activities and share any additional learning preferences.
Student Full Name
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Which liberal arts activities are you interested in? (Select all that apply)
Art (drawing, painting, sculpture)
Music (singing, beats, instruments)
Theater/Drama
Creative Writing
Dance
Debate/Public Speaking
Other
Which S.T.E.M. activities are you interested in? (Select all that apply)
Science Experiments
Math Games/Challenges
Robotics
Coding/Programming
Engineering Projects
Technology/Computers
Other
Is there anything else you would like to learn or any other activities you are interested in?
Submit
Should be Empty: