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Using this Form
Use this form to add yourself to our National Student Directory! By submitting the form below, you will allow us to share your contact information with faculty and staff associated with STEM programs that support students, and to email you periodically with assistance in finding programs that are compatible with your interests. You will be given an option to provide additional details about your academic interests. If you choose to do this, you can expect to spend 3-4 minutes completing this portion of the form.
Required Fields are marked with a
*
**Please note: This form is for inquiring about programs only. It is not an application form.
Download this form as a PDF
Tell us About Yourself
*First Name
:
Middle Name:
*Last Name
:
*Email Address
:
Alternate Email Address:
*Your Current Academic Status
:
-- Please Select --
High School Freshman
High School Sophomore
High School Junior
High School Senior
Undergraduate Freshman
Undergraduate Sophomore
Undergraduate Junior
Undergraduate Senior
Post-Baccalaureate
Masters Student
Ph.D. Student
Postdoctoral Researcher
Other
*Your Academic Interests, Current Major or Research Area
:
or check here if undecided
Your current institution
If your institution is
not
an option included above, enter it here:
*Ethnicity:
-- Please Select --
African American
Asian American
Caucasian
Native American Indian
Mexican American
Pacific Islander
Puerto Rican
Other Hispanic
Other
Decline to Answer
If Ethnicity Other:
Citizenship:
US/Permanent Resident
Non-US
Have you participated recently in any conferences or STEM educational program/event(s)?
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