The World Food Prize

WFP Purdue Youth Institute Registration Form

Please complete the online registration form for your student by March 8, 2013 for the 2013 World Food Prize Youth Institute at Purdue University. Due to space limitations, registration does not guarantee participation.

Once you have submitted your online form, Donna Keener or Kelly Delp, the Indiana State Coordinators, will officially confirm your registration.

* denotes a required field.
School Name: *
School Address: *
School City: *
School State: *
Use State Acryonym (ex: IA, MN, OH, NY)  
School Postal Code: *
School Phone: *
Numerals Only (ex: 5152453783)  
School Fax:  
Numerals Only (ex: 5152453785)  
Principal Prefix: *
Dr.
Mr.
Mrs.
Ms.
Principal First Name: *
Principal Last Name: *
Teacher Prefix: *
Dr.
Mr.
Mrs.
Ms.
Teacher First Name: *
Teacher Last Name: *
Teacher's Sex: *
Female
Male
Teacher School E-mail: *
Teacher Home E-mail:  
Teacher Home Address: *
Teacher City: *
Teacher State: *
Use State Acryonym (ex: IA, MN, OH, NY)  
Teacher Postal Code: *
Teacher Home Phone:  
Numerals Only (ex: 5152453783)  
Teacher Cell Phone: *
Numerals Only (ex: 5152453783)  
Student First Name: *
Student Last Name: *
Student's Sex: *
Female
Male
Student E-mail: *
Student Home Address: *
Student City: *
Student State: *
Use State Acronym (ex: IA, MN, OH, NY)  
Student Postal Code: *
Student Home Phone: *
Student Cell Phone:  
Numerals Only (ex: 5152453783)  
Student Research Paper Upload: *
Select the button to the right to locate and submit your student's research paper. Paper must be in WORD format (.doc or .docx files only).  
(doc,docx)
Student Year in School: *
As of Fall 2013  
Freshman
Sophomore
Junior
Senior
Check the boxes of organizations student is a member: *
FFA
4-H
HOBY
Science Fair
Model UN
TAG/ELP
Is the student's GPA 3.25 or higher?: *
Yes
No
Local Newspaper Name: *
Local Newspaper E-mail:  
Other Local Media Name:  
Other Local Media E-mail:  
 
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