Family Math Fun Series Registration

First Name: Last Name: Email: Day Phone: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix How did you hear about this event? Number of Attendees: How often does your family play with math toys and math games with one another? Very often Often Sometimes Rarely Never How often does your family use math words to describe actions, spaces, and the world around you? Very often Often Sometimes Rarely Never How often does your family connect math to everyday surroundings, interactions, and interests? Very often Often Sometimes Rarely Never How confident are you as a parent or caregiver in guiding your child(ren) to learn about math? Very confident Somewhat confident Neutral Occasionally confident Not at all confident SUMM, Zeno, and Math Empower Family’s missions are about having more people love math. How do you currently feel about math? Love math Like math Math is okay Dislike math Hate math How often do you use math in your daily life? Very often Often Sometimes Rarely Never How is math used in your community and home life? Does your family experience any barriers related to learning/teaching math? If yes, please describe. When you picture a helpful community organization, what comes to mind? How can our community organization strengthen partnering with families? How do you publicly self-identify? (Multi-select) Which language(s) do you speak in your home? (Multi-select) If you selected "Other" please enter the language(s) you speak here. What is your age? 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75-84 years old What is your relation to the student? Mom Dad Sibling Grandparent Stepparent Aunt Uncle Cousin Other If you selected "Other" please enter your relation to the student here. What is the highest level of education you have completed? Bachelor's Degree Master's Degree Associate Degree High school diploma or equivalent (e.g. GED) Doctorate Less than a high school diploma Trade or certification program N/A What is your average household income? Less than $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 Over $100,000 N/A Who lives at home with the student? (Multi-select) If you selected "Other" please enter who lives at home with the student here. I grant permission for SUMM and Zeno to use my and my child(ren)’s image in any film and photography during our participation in events for use as described above. If I want to withdraw my consent in any instance, I will let staff know.