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Student Information
 
 
* Name
   
* Email
   
* Address
   
* City
   
* State
   
* Zip
   
Phone
   
Raffle Code
   
 
 
Yes! I want to learn more about Advanced High-Tech Manufacturing.
Areas of Interest:

 
Apprenticeships/Trades
 
Facilities Technology
 
Precision Machinery
 
Electronics/Electromechanical Systems
 
Math, Science and Technology
 
Financial Aid
 
University Transfer
 
Undecided
 
Other
 

 
 
 
How did you learn about us?

 
Recruiter
 
Counselor/Advisor
 
Community Center
 
Web
 
Newspaper
 
Other
 
 
 
 
Where are you on your career path?
 
In high school
 
Graduating high school senior
 
College student
 
Already in the workforce
 
 
 
Intended Enrollment Date:
 
Fall
 
Summer
 
Spring
 
Currently Enrolled
 
Not Sure
 
Year:
 
 
 
 
Gender:

 
Male
 
Female
 
 
 
Birthdate (Month/Year):
   
 
 
 
Ethnicity* (*Voluntary information requested for affirmative action and equal opportunity reporting purposes)
 
American Indian
 
Black (Non-Hispanic)
 
Asian
 
White (Non-Hispanic)
 
Other
 

 
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