TIC Registration Information

Educators who wish to participate in in Trout in the Classroom for the 2018-2019 school year must complete the registration form. This form serves as your Brook Trout egg application.

If you forget something or need to make changes, email those changes to PA Fish and Boat Commission's Trout In Classroom Coordinator adaniel@pa.gov

Question Title

* 1. Lead Teacher Name

Question Title

* 2. Date of Birth

Date

Question Title

* 3. School Building/Organization Name

Question Title

* 4. School Shipping Address. Please use complete information. This address will be used to ship trout eggs via UPS. UPS cannot deliver to PO Boxes.

Question Title

* 5. State

Question Title

* 6. Please provide the 5 digit zip code for the shipping address.

Question Title

* 7. Please provide a daytime phone number.

Question Title

* 8. If your daytime phone number has an extension, please enter it here.

Question Title

* 9. Please provide an alternate phone number.

Question Title

* 10. If your alternate phone number has an extension, please enter it here.

Question Title

* 11. Please provide an email address. (It is very important that your email address is correct, otherwise you will miss important TIC updates and notices)

Question Title

* 15. Provide your School District Name (NOTE- Even if your school/organization is private or a charter school, you are still within a school district. USE this link to find the name of your school district.) http://www.dot7.state.pa.us/BPR_PDF_FILES/MAPS/Education/Statewide_IU_and_Districts.pdf

T