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W.TEC Girls' Technology Camp Nomination Form


Thank you for your interest in the W.TEC Girls' Technology Camp. Please fill out all the fields of this form and click "Submit" after you are finished.

Nomination 1:

  • First Name:

  • Last Name:

  • Class:

  • Age:

  • School:

  • Contact Address:

  • Phone Number:

  • Email Address:

  • Relationship with you:


Nomination 2:

  • First Name:

  • Last Name:

  • Class:

  • Age:

  • School:

  • Contact Address:

  • Phone Number:

  • Email Address:

  • Relationship with you:


Other:

How did you hear about this program?

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