NanoDay Registration


* indicates required fields

High School Class Request for Participation

Name of High School: *

School Location (City and State): *

Class/Group Name (i.e. Biology Class, Chemistry Class, AP group, etc.): *

Class Level (i.e. 9th grade, mixed grades, 11th and 12th grades): *

Does your class/group consist largely of underrepresented groups in the sciences and engineering? Or of students who have few school-provided science enrichment opportunities? If yes, please explain.:

Does your school currently have a Nanotechnology or similar type of program?

Do you anticipate any problems with arriving by 9:30am and departing at 2:00pm: *
Activities will be located in buildings close to the intersection of 33rd St. and Walnut St., on the University of Pennsylvania campus.
Yes No Other
Comments:

If your group is invited to attend, do you foresee any issues with attending (committing to come and attending)? *
Yes No Other
Comments:

Has Your School Ever Participated in Past NanoDay Events?: * Yes No
If yes, what year did they last participate?

 

Contact Information:

First Name of Primary Teacher: *

Last Name of Primary Teacher: *

Primary Teacher’s Email Address: *

Primary Teacher’s Cell Phone Number: *

Note: We require a cell phone number in case of emergency on the day of the event. All other primary correspondence will be done through email.

Total Number of Teachers/Chaperones Attending: *

Additional Names of Teachers/Chaperones:

Number of Participating Students: *