Registration

Step 1 of 2: Your Profile

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First Name:

Last Name:

Email Address:

New Password: must be at least 10 characters long

Town or City:

Job Title:

Introduce Yourself in a Sentence:

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Guardian 1 - Full Name:

Guardian 1 - Phone Number:

Guardian 1 - Email Address:

Guardian 1 employer "We collect information from all families to further our community engagement and outreach":

Guardian 2 - Full Name:

Guardian 2 - Phone Number:

Guardian 2 - Email Address:

Guardian 2 employer "We collect information from all families to further our community engagement and outreach":

Activist alternate email address(if any):

Activist phone number:

Full Address *:

Zipcode*:

State*:

Name of Current School (official name, no abbreviation):

If your school is outside of the Louisville Metro Area or not listed in the drop down above, please add it here:

Current School Grade:

Gender*:

Have you been a previous EJ participant? If so, how many years?:

How did you learn about Educational Justice ?:

In terms of ethnicity, how do you self-identify? (Check all that apply) *:

Other Spoken Languages:

What do you like to read?:

Interests:

Days of the week where you can be available for tutoring sessions between 5 and 9 PM on Weekdays, or 11-6PM on Weekends (Choose at least 2 days):

If you were referred by a current EJ Activist Tutor, please list their first and last name here:

Why do you want to become an EJ Activist? What appeals to you most about the program?:

Why do you believe you would be a good fit for the EJ Activists Honor Society?:

Please list all of your extracurricular activities, including any jobs:

Month of Birth:

Current Unweighted GPA:

I have read and understood PushFar's Terms of Use

I have read and understood PushFar's Privacy Policy

Organisation Notice

Educational Justice is located at 200 York Street, Louisville, KY 40203