Young Women Empowered · 2023 STEM Day Signup

Contact Information

Name

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First Name

Last Name

What are your gender pronouns? (optional)

she/her, they/them, he/him, etc.

What is your age range?

*

Email

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Verify Email

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Optional: Phone Number

Do you have any dietary restrictions or food allergies? (for example: vegetarian, halal, allergic to peanuts, etc).

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Do you have any medical considerations or major allergies we should know about in the event of an emergency? (for example, anaphylactic bee allergy, diabetic, etc)

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Are there any accommodations you need to make this program accessible and comfortable? (physical space needs, technology support, environmental sensitivities, etc). If none, please write 'none.'

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Y-WE is dedicated to creating inclusive spaces and programs for all, including people with disabilities and specific accommodation needs.

Will this be your first Y-WE event/activity?

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Optional: How did you hear about this event?

If you are in school, what school do you attend?

Demographic Information

Y-WE collects this data to better understand who we serve, and to improve and obtain support for our programs. Your answers are confidential and will not be shared outside of Y-WE except as part of anonymous percentages.

Are you willing to answer a few short demographic questions? This information helps Y-WE better understand who we serve and obtain support for our programs. Answers are confidential and not shared outside Y-WE except as part of anonymous percentages.

*

Select 'Yes' to see the questions. If you change your mind, just reselect 'No' and the questions will disappear. Each question is optional!

Do you identify as Black, Indigenous, or a Person of Color?

If you selected 'Other' please describe (optional)

Do you identify as LGBTQIA+? (select any/all that apply, or select 'prefer not to answer')

If you selected 'Other' please describe (optional)

Emergency Contact

For participants under 18, the emergency contact must be a parent/guardian.

Emergency Contact Name

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First Name

Last Name

Relationship to Participant (parent, spouse, friend, etc)

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Emergency Contact Phone Number:

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Young Women Empowered Presents...

STEM Day 2023

February 11th, 11am - 4pm

Seattle Public Library Downtown Branch: 1000 4th Ave, Seattle, WA 98104

If you have any needs or questions, contact Mary (she/her) at mary@y-we.org