Office Hours Registration
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Subject of your inquiry for MAGE? (Check all that apply)
*
Learn about Gifted Education in MA
Help understanding options to support my child's particular needs
Interested in learning more about advocacy efforts in MA
Consultation support in advocating for my child in their school
Organization wishing to connect/network with MAGE
Other
I am a member of MAGE:
*
Yes
No
How did you learn about MAGE?
*
Google, Social Media, Therapist, Neuropsychologist, Friend? If possible, share a name so we can thank them too!
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Student Information
We collect the following information to understand who is accessing our services as part of our work to deliver inclusive services. Please complete each section for each student you represent.
Student Age
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
No Student
How old is the student?
Grade
*
Please Select
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Higher Education
Post Graduate
What grade level is the student in?
Schooling Situation
*
Please Select
Public
Private
Homeschool
Virtual
Other
How old is your 1st child?
School Zip Code
*
What is the zip code of school?
Provide demographic data for this student?
*
Yes
No
Gender
*
Optional
Transgender or gender diverse?
*
Please Select
Yes
No
Prefer not to answer
Optional
Ethnicity
*
Please Select
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other/Unknown
Optional
Household Income
*
Please Select
Under $20,000
$20,001 – $40,000
$40,001 – $60,000
$60,001 – $80,000
$80,001 – $100,000
$100,001 or over
Unknown
Prefer not to answer
Optional
Add another student?
Yes please.
Student 2 Age
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
No Student
How old is the student?
Grade
*
Please Select
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Higher Education
Post Graduate
What grade level is the student in?
Schooling Situation
*
Please Select
Public
Private
Homeschool
Virtual
Other
How old is your 1st child?
School Zip Code
*
What is the zip code of school?
Provide demographic data for this student?
*
Yes
No
Gender
*
Optional
Transgender or gender diverse?
*
Please Select
Yes
No
Prefer not to answer
Optional
Ethnicity
*
Please Select
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other/Unknown
Optional
Household Income
*
Please Select
Under $20,000
$20,001 – $40,000
$40,001 – $60,000
$60,001 – $80,000
$80,001 – $100,000
$100,001 or over
Unknown
Prefer not to answer
Optional
Add another student?
Yes please.
Student 3 Age
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
No Student
How old is the student?
Grade
*
Please Select
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Higher Education
Post Graduate
What grade level is the student in?
Schooling Situation
*
Please Select
Public
Private
Homeschool
Virtual
Other
How old is your 1st child?
School Zip Code
*
What is the zip code of school?
Provide demographic data for this student?
*
Yes
No
Gender
*
Optional
Transgender or gender diverse?
*
Please Select
Yes
No
Prefer not to answer
Optional
Ethnicity
*
Please Select
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other/Unknown
Optional
Household Income
*
Please Select
Under $20,000
$20,001 – $40,000
$40,001 – $60,000
$60,001 – $80,000
$80,001 – $100,000
$100,001 or over
Unknown
Prefer not to answer
Optional
Add another student?
Yes please.
Student 4 Age
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
No Student
How old is the student?
Grade
*
Please Select
Preschool
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Higher Education
Post Graduate
What grade level is the student in?
Schooling Situation
*
Please Select
Public
Private
Homeschool
Virtual
Other
How old is your 1st child?
School Zip Code
*
What is the zip code of school?
Provide demographic data for this student?
*
Yes
No
Gender
*
Optional
Transgender or gender diverse?
*
Please Select
Yes
No
Prefer not to answer
Optional
Ethnicity
*
Please Select
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Two or More
Other/Unknown
Optional
Household Income
*
Please Select
Under $20,000
$20,001 – $40,000
$40,001 – $60,000
$60,001 – $80,000
$80,001 – $100,000
$100,001 or over
Unknown
Prefer not to answer
Optional
When you click submit, you will be entered into the Office Hours Zoom Meeting, held every Thursday from 9:30-10:30am eastern.
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