Participant Sign Up

Join the Peer Resources program for the 2009 school year.

* required information.
School *
First Name *
Last Name *
Date of Birth (mm/dd/yyyy)*
Address
City
State
Zip
Phone
Mobile
Email Address
Primary Language (select one)
Additional Language Proficiencies NOTE: Hold down the Ctrl or Apple key to select multiple items from a list
Please specify any additional language proficiencies not listed above:
Primary Ethnicity Select the ethnicity with which you primarily identify.
Primary Ethnicity (other) Please specify your primary ethnicity here if you selected one of the "Other" options above:
Secondary Ethnicity Select the ethnicity with which you secondarily identify.
Secondary Ethnicity (other) Please specify your secondary ethnicity here if you selected one of the "Other" options above:
Gender
Grade Level
How did you find out about Peers? NOTE: Hold down the Ctrl or Apple key to select multiple items from a list
Why did you become a Peer Resources Participant?