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Net Buddy Intake

Registration Form
First Name:*
Last Name:*
Nickname:
Meaning of Name:
Country:
Country of Birth:
Date of Birth:
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Birth Order:
Gender:
NGO:
Mobile:
Skype ID:
FaceBook ID:
Twitter:
Linked In:
First Career Choice:
Second Career Choice:
3 Words that describe NB:
3 Words that do not describe NB:
Languages Spoken:
Other Languages Spoken:
Has Baseline Access To:
Baseline Computer Literacy:
Uses Cell Phone for:
No cell phone access: Does it matter? Why?:
Uses Computer for:
No computer access: Does it matter? Why?:
Uses Internet for:
No internet access: Does it matter? Why?:
Uses Tablet for:
No tablet access: Does it matter? Why?:
Net Buddy gets information for school and homework from:
Other SW/HW, please specify:
Net Buddy gets information about higher education from:
Other HE, please specify:
Net Buddy gets information about future careers from:
Other FC, please specify:
Net Buddy gets information about other teen opportunities from:
Other Ops Y, please specify:
School:
Education Grade / Level:
Education level as of (MM/DD/YYYY):
Preferred Study Subjects:
Challenging Study Subjects:
Post-Matric Plans:
Other PM Y, please specify:
Check the box below: