Form Test

Name* (First and Last):

My.polk.edu Email*:

Phone Number:

Program of Study:

Age:
Under 18 (will need parental consent)18 – 2627 – 3839+

Gender:
MaleFemaleNon-binaryTransgenderOther

Race/Ethnicity:
Hispanic or LatinoBlack or African AmericanWhiteAsianNative Hawaiian or Other Pacific IslanderAmerican Indian or Alaska NativeOther

Height:
Shorter than 5'5’ – 5’45’5 – 5’96’ or taller

Willing to travel to:
Winter Haven CampusLakeland CampusAdvanced Technology Center in BartowJD Alexander Center in Lake WalesCenter for Public Safety in Winter Haven

If you have an Instagram or a Facebook, please provide us with your username(s):

Comments or questions?: