2021 Virtual Women in Science Conference: Teacher/Student Registration Form

REGISTRATION OPENS: TUES., DEC. 8, 2020 @ 10 A.M.
LIVE VIRTUAL CONFERENCE DATE: FEB. 23, 2021
A recorded version of the conference will be available online thereafter.

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PLEASE NOTE: THE MAXIMUM NUMBER OF STEM KITS (1,500) HAVE BEEN DISTRIBUTED; THERE ARE NO MORE AVAILABLE. However, you can still register to participate in the event! You can engage in the interactive women in science panel discussion, which doesn't require any hands-on materials. Also, we will be providing registered attendees with a list of materials needed for some of the key interactive booths--you can gather those items and join in!

This registration form is to be used by teachers who wish to register themselves and their students (grades 6-12) to participate in the 2021 virtual Women in Science Conference.

Benefits of registering for the conference include:

Students of registered teachers can submit questions for our Women in STEM Careers panelists; select questions will be answered live during the event!
Conference log-in information and other event details for the live event will be provided to registered teachers!

Thank you for your participation in the conference and for your support of women in science! Questions? Email gmiller@okepscor.org or call 405.744.9964.

IMPORTANT: BE SURE TO CLICK THE SUBMIT BUTTON at the bottom of the page after completing the form. You will receive a confirmation email after submitting your form. If you do not receive immediate confirmation, email gmiller@okepscor.org right away, as your registration was not received.

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School Information

School Name: *

School Address: *

Teacher

Teacher Info.

First Name: *

Last Name: *

Email: *

Phone (405-555-1234 format): *

Teacher Demographic Information

Your assistance in providing demographic information will allow us to fulfill the requirements of the National Science Foundation (NSF), the primary funding agency of OK EPSCoR and the Women in Science Conference. Data reported to NSF will not include any personal identifying information; all information will remain confidential.

Gender: *

Ethnicity: *

Race: *

Other Race:

Disability: *

Other Disability:

Citizenship: *

Other Citizenship:

Student Information

An unlimited number of students may register to participate in the conference! However, the maximum number of STEM kits (1,500) have been reserved--there are no more kits available to distribute, so registrants will need to acquire their own materials for the hands-on activities.

Grade Level of Students Attending Event : * Indicate a range if needed.

Total # Students Attending: *

# of Female Students: *

# Male Students: *

# American Indian Students: *

# Asian Students: *