Women in Engineering Open House

Email Address

First Name

Last Name

Total Attendees (including registrant)

Parent/Guardian Email (will be copied on information regarding parking, directions, etc.)

Gender

Birthdate

Mailing Address

Country
Street
City
Region
Postal Code

High School Name

School CEEB

Year of Enrollment

2019

2020

2021

Academic Interests:

Are you Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please indicate how would you identify yourself?

American Indian or Alaska Native

Asian (including Indian subcontinent and Philippines)

Black or African American (including Africa and Caribbean)

Native Hawaiian or other Pacific Islander

White (including Middle Eastern)

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