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:

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

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