Pacific Lamprey Project Registration * 1. Please share information about you and your school. One teacher or school staff can register multiple classrooms. Name: School Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email Address: Phone Number: * 2. Which grade(s) will be involved? Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 * 3. How many classrooms will be involved in the program? One two three four more than four * 4. Approximately how many students will participate in this project? * 5. Which of the following media device (s) will you use with your students in this project Computer tablets (i.e. Ipad) School Computer lab Classroom computers Other (please specify) * 6. Please tell us the approximate time of year your students will participate in this project? * 7. Would you school be interested in receiving a follow up visit by a USFWS staff to present certificates of completion to students and to answer follow-up questions from students? Yes No Maybe Comments Done
