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2024 Black College Expo Field Trip Registration
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This form will be used to collect interest from students about attending the Black College Expo with 10KD.
9/25/204 -
clone from COS 2024
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Thank you for your interest in attending the 10,000 Degrees Black College Expo Field Trip at Sacramento State on November 2nd, 2024! Transportation will be provided to students on a first come first served basis.
Please complete the application below to register your attendance and secure your transportation.
I am a student in
High School
College
Contact Information
Student's first name
Student's middle initial
Student's last name
Preferred
First Name
The name you prefer to be called.
Student's
personal
email address
Confirm student's personal email address
Student's cell phone number
Student's ZIP/postal code
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
His/Her/Their email address
Please confirm his/her/their email
His/Her/Their phone number
How is this person related to you?
Parent
Stepparent
Foster Parent
Legal Guardian
Grandparent
Sibling
Aunt
Uncle
Other
Please write how this person is related to you.
Would you like to provide additional Parent/Guardian information?
Yes
No
Second Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
His/Her/Their email address
Please confirm his/her/their email
His/Her/Their phone number
How is this person related to you?
Parent
Stepparent
Foster Parent
Legal Guardian
Grandparent
Sibling
Aunt
Uncle
Other
Please write how this person is related to you.
High School Information
What high school do you attend?
Please type "Other" if your high school does not appear in our list.
If you typed "Other" above,
please provide the following information about your school.
In which part of the Bay Area is your high school located?
Contra Costa
Lake County
Marin
Napa County
San Mateo
Santa Clara
SF Region
Sonoma
South Bay
Other
What is the name of your high school?
What year will you graduate from high school? Please type the full year.
College Information
What college do you attend?
Please type "My college does not appear on this list" if your college does not appear in our list.
If your college does not appear on the list above,
please provide the following information about your school.
In which part of the Bay Area is your school located?
Contra Costa
Lake County
Marin
Napa County
San Mateo
Santa Clara
SF Region
Sonoma
South Bay
Other
What is the name of your college?
When do you plan to transfer to a 4-year college?.
Please select...
Fall 2025
Spring 2026
Fall 2026
Further in the future
Autosuggest Field Mapping
High School Account ID
College Account Account ID
Email Notifications to
Contact Owner ID
Contact Owner Name
Geographic Area
Demographic Information
Birthdate (please enter in MM/DD/YYYY format)
Please format the date as MM/DD/YYYY.
x
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.
Are you or have you ever been in Foster Care?
Yes
No
Are you or have you ever experienced homelessness?
Yes
No
Are you (or a sibling) the first in your family to pursue college in the United States?
Yes
No
I don't know
Please answer "Yes" if your parents attended college in the United States but have not attained a Bachelor's degree or higher.
x
Do you have a sibling that is a current student or an Alumni of 10,000 Degrees?
(has received a scholarship or participated in our programs)
Yes
No
What is that sibling's name?
What language do you prefer to communicate in?
Food Restrictions & Transportation
Do you have any dietary restrictions that you would like us to be aware of? Please specify.
If transportation is provided to and from the event, would you like to take it?
Yes
Maybe
No
Please select your preferred T-shirt size for the trip:
Please select...
XS (Extra Small)
S (Small)
M (Medium)
L (Large)
XL (Extra Large)
XXL (Double Extra Large)
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 write how you heard of this opportunity.
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