Gift Card Form & Demographics
First Name
Please use the first name you were enrolled with
Last Name
Please use the last name you were enrolled with
Email Address
Please use your personal or school email
Gift Card Information
Choose your gift card type:
Amazon Gift Card
Target Gift Card
How would you like to receive your gift card?
Digital gift card sent by email
Digital gift card sent by text
Physical gift card sent by mail
Digital Gift Card | Email
Email Address
Digital Gift Card | Text
Phone Number
Physical Gift Card | Mail
Street Address
City
Zip Code
Share how you identify:
Why do we ask these questions?
We ask for demographic information to learn more about those who participate in this program and to share with the people who provide the money for the gift cards. This section is optional, but we love to know more about you.
Do you identify as:
Cisgender
Transgender
Not sure
Prefer not to answer
Your gender identity is:
Non-Binary
Woman/girl
Man/boy
Agender
Gender Non-Conforming
Prefer not to answer
Your racial/ethnic identity is:
American Indian/Native American
Asian American and/or Pacific Islander
Black or African American
Middle Eastern/North African
White
Prefer not to answer
Please check all that apply to you
Do you identify as Latinx/Hispanic?
Yes, I am Latinx/Hispanic
No, I am not Latinx/Hispanic
Prefer not to answer
Do you identify with two or more racial identities?
Yes; I am multiracial
No; I am not multiracial
Prefer not to answer
My age group is:
11 or younger
12 - 14 years old
15 - 17 years old
18+
"I have read and understand the gift card process."
Yes
No
Hey, please read this. Thanks! (:
"I have read and understand the gift card process."
Yes
Do you have additional questions or concerns?
Thank you for filling out the Gift Card Form. Press the "Submit" button to record your responses.
Total participants this session
Yes
Contact Information