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2025-26 Girls Inc. of Alameda County: Eureka! Application

Applicant Portion

This segment is for the youth who is applying, below there will be some questions the parent/guardian must complete to submit the application.

1. Applicant's Full Name *This question is required.

2. Applicant's Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

3. Applicant's Primary Home Address *This question is required.

Street Address/P.O. Box
City
State
ZIP

4. Applicant's Cell Phone (if applicable) *This question is required. This question requires a valid number format.

5. Applicant's Email Address *This question is required. This question requires a valid email address.

6. Please select your preferred method of contact *This question is required.

Email
Cell Phone

7. What middle school do you currently attend? *This question is required.

8. What grade are you currently in? *This question is required.

9. What Race/Ethnicity do you identify as? Please check all that apply.
(optional, for statistical purposes only)

10. How did you learn about Eureka? Please list name(s) if applicable. *This question is required.

11. Are you involved or have you been involved with any Girls Inc. programs?
(Select all that apply) *This question is required.

K-3rd Grade
4th-5th Grade
Girls Resource Center
ALL STARS
Concordia Summer Camp
Not applicable
If you attended a Girls Inc. Afterschool program, please name the school here: Please enter an 'other' value for this selection.

12. Do you have family members who have been part of the Girls Inc. Program?
(Please list there name and the program they were in) *This question is required.

13. Are you involved in any extracurricular activities in or out of school, including sports teams? If applicable, please list activities: *This question is required.

14. Why do you want to be part of the Eureka! Program?
(Please answer in two to three sentences) *This question is required.