Eclipse Project Sign-up Form

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Mar 30

2017

by Zoe Chee

Published: Thursday, March 30 2017 02:58

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Sign Up for Eclipse Education Project Updates:

First Name*

Last Name*

Name of Organization of Group You Intend to Work with

Street Address*

City*

State* Please select your state AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip*

Email*

Alternate Email (optional)

How did you hear about this program? NSTA Co-worker or friend AWB website/social media Newspaper or magazine article Postcard STAR science education program Night Sky Network Project Astro Museum Alliance NISEnet STAR_Net community NASA Eclipse Website GreatAmerican Eclipse Website Other

Please describe

I am a: Teacher School administrator Librarian Museum Professional Afterschool Provider Amateur Astronomer Scout Leader Planetarium Staff Other Group Leader

Specify

Grade(s) Taught K 1 2 3 4 5 6 7 8 9 10 11 12 Afterschool

Topics Taught Earth and Space Science Life Science Physical Science Language Arts Mathematics Engineering/Technology Social Studies History Other

Specify

Number of students I might use this program with

If known, the percentage of students who receive free and reduced price lunch in your school

Will schools in your area be in session August 21, 2017? Yes No

Name of Building and District

Number of teachers in your building and district

Number of students in your building and district

If known, the percentage of students who receive free and reduced price lunch in your school

Will your school and/or district be in session on August 21, 2017? Yes No

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

If known, the percentage of students who receive free and reduced price lunch in your service area

Will schools in your service area be in session on August 21, 2017? Yes no both I don't know

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

If known, the percentage of students who receive free and reduced price lunch in your service area

Will schools in your service area be in session on August 21, 2017? Yes no both I don't know

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

If known, the percentage of students who receive free and reduced price lunch in your service area

Will schools in your service area be in session on August 21, 2017? Yes No both I don't know

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

If known, the percentage of students who receive free and reduced price lunch in your service area

Will schools in your service area be in session on August 21, 2017? Yes No both I don't know

Describe the type and level of Scout Group (Boy Scouts, Brownies, Campfire Girls etc.)

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

Will schools in your service area be in session on August 21, 2017? Yes No both I don't know

Describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

If known, the percentage of students who receive free and reduced price lunch in your service area

Will schools in your service area be in session on August 21, 2017? Yes No both I don't know

If you represent an amateur astronomy club, enter name here

Are you already partnered with a local group of students, kids or families? Yes No

If yes, describe the types of people you might use these materials with: Kids ages 0-5 Kids ages 6-10 Kids ages 11-13 Kids ages 13-18 Families Afterschool Groups General Public other

Specify

Are you interested in being matched with a(nother) group to support? Yes No

Will schools in your service area be in session on August 21, 2017? Yes No both I don't know

Submit

Thank you for signing up for the AWB Eclipse STEM Education Project.
Stay tuned for more information!