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June 5th Grade Program Registration Form

Registration opens immediately. Deadline for applications is Monday May 10th 2013. Only receipt of a registration form will ensure a schools placement in the program based on the guidelines for participation. Program check-in time is 8:45am. Program ends at 1:30pm.


School *


Name of Teacher Contact *


E-mail *


Phone Number *


Number of Students Attending *


Choose the date of your FIRST choice. *


Choose a SECOND date of choice is the 1st date is not available. *


I understand that my students will need to bring lunch. I understand students will need to wear closed toe shoes (no sandals). *
 Yes
 I wish to speak to the STEM Outreach Coordinator to clarify student expectations.


I have read the general guidelines for registration and selection process for participating schools. (Guidelines can be found at the "A Day of STEM Exploration" homepage.) *
 Yes
 I wish to speak to the STEM Outreach Coordinator to clarify the registration and selection process.


If necessary, use the space below to communicate any additional information to the STEM Outreach Coordinator (date choices, special needs).