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High School Readiness Summit 2024-25
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This form is used by the Early College & Career Awareness team in order to gather registration information (for the High School Readiness Summit) from students who both have and lack a Contact in Salesforce. This form was cloned from the Early College & Career Awareness Onboarding Application.
2/20/2024 Cloned from HSRS app 2023-2024
Email doesn't match message (bilingual)
Please submit this form to apply to the 10,000 Degrees High School Readiness Summit.
Student's
personal
email address
Please confirm your
personal
email address
What middle school are you attending now?
Hamilton TK-8 School
San Jose Middle School
Sinaloa Middle School
Dr. Martin Luther King Jr. Academy
West Marin Elementary School
Tomales Elementary School
What grade will you be in August 2024?
Please select...
9th Grade
10th Grade
11th Grade
12th Grade
What high school will you attend in August 2024?
San Marin High School
Novato High School
Tomales High School
Tamalpais High School
My high school does not appear on this list
Account Id
What is the name of your high school that does not appear in the list above?
Page Comments
A conditional page that only shows when "English" is selected on the first page.
Email doesn't match message (make this field hidden)
Student's Contact Information
Student's first name
Student's middle initial
Student's last name
Student's
preferred first
name
Student's cell phone number
Mailing Street
Mailing City
Mailing State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Mailing Zip Code
Demographic Info
What is the student's preferred language?
American Sign Language
Arabic
Cantonese
Creole
English
Hindi
Japanese
Khmer
Korean
Mandarin
Portuguese
Punjabi
Spanish
Tagalog
Thai
Urdu
Vietnamese
Other
What language do you prefer?
Date of Birth
Gender
Please select...
Male
Female
Trans woman
Trans man
Gender Non-Conforming/Non-Binary
Prefer not to disclose/Not listed
Gender Pronouns
Please select...
She/Her/Hers
He/Him/His
They/Them/Theirs
Not Listed
What are your gender pronouns? (Optional)
Ethnicity
Please select...
American Indian/Indigenous American or Alaska Native
Asian
Black/African American
Hispanic/Latino/a/x
Middle Eastern/North African
Pacific Islander
White
Multiracial/Multiethnic
Not listed /prefer to self-describe
If you would like to indicate your tribal affiliation, please do so here.
Burmese
Cambodian
Chinese
Hmong
Indian
Indonesian
Japanese
Filipino
Korean
Laotian
Malaysian
Mien
Pakistani
Taiwanese
Thai
Tibetan
Vietnamese
Not listed
African
African American
Afro-Caribbean
Afro-Latino
Not listed
Argentinean
Bolivian
Brazilian
Chilean
Colombian
Costa Rican
Cuban
Dominican
Ecuadorian
Guatemalan
Honduran
Mexican/Chicano
Nicaraguan
Panamanian
Peruvian
Puerto Rican
Salvadoran
Spanish
Venezuelan
Not listed
Assyrian, Syriac or Chaldean
Egyptian
Iranian or Persian
Iraqi
Israeli
Jordanian
Lebanese
Moroccan
Palestinian
Syrian
Turkish
Other Middle Eastern
Not listed
Chamorro
Fijian
Native Hawaiian
Samoan
Tongan
Not listed
European
Not Listed
American Indian or Alaska Native
Asian
Black/African American
Hispanic/Latino/a/x
Pacific Islander
White
Multi-racial
Not listed
Please describe your ethnicity.
Would you (or a sibling) be the first in your family to pursue college?
Yes
No
I don't know
How did you hear about this opportunity?
10,000 Degrees Email
10,000 Degrees Social Media
10,000 Degrees Staff Member
10,000 Degrees Website
Community Organization
Friend
School Counselor
School Email
School Staff
Other
Please let us know about any dietary restrictions or food allergies the student has.
Contact Information for a Parent/Guardian or someone you may live with
Parent/Guardian First Name
Parent/Guardian Last Name
His/Her/Their phone number
How is this person related to you?
Parent
Stepparent
Foster Parent
Legal Guardian
Grandparent
Sibling
Uncle/Aunt
Other
Prefer not to say
Please write how this person is related to you.
What is their preferred language?
American Sign Language
Arabic
Cantonese
Creole
English
Hindi
Japanese
Khmer
Korean
Mandarin
Portuguese
Punjabi
Spanish
Tagalog
Thai
Urdu
Vietnamese
Other
Are you able to provide an email address for the person above?
Yes
No
His/Her/Their email address
Confirm His/Her/Their email address
Please click
Submit
only once. The form will process your responses.
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