The World Food Prize

WFP Purdue Youth Institute Registration Form

Please complete the online registration form for your student by March 24, 2014 for the 2014 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 (example: 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/Mentor Prefix: *
Dr.
Mr.
Mrs.
Ms.
Teacher/Mentor First Name: *
Teacher/Mentor Last Name: *
Teacher's Discipline: *
Courses taught (biology, ag ed, history)  
Teacher/Mentor Gender: *
Select all that apply.  
Female
Male
Transgender
Teacher/Mentor Work E-mail: *
Teacher/Home Home E-mail:  
Teacher/Mentor Home Address: *
Teacher/Mentor City: *
Teacher/Mentor State: *
Use State Acryonym (ex: IA, MN, OH, NY)  
Teacher/Mentor Postal Code: *
Teacher/Mentor Home Phone:  
Numerals Only (ex: 5152453783)  
Teacher/Mentor Cell Phone: *
Numerals Only (ex: 5152453783)  
Student First Name: *
Student Last Name: *
Student Gender: *
Select all that apply.  
Female
Male
Transgender
Student E-mail: *
Student Home Address: *
Student City: *
Student State: *
Use State Acronym (ex: IA, MN, OH, NY)  
Student Postal Code: *
Student Home Phone: *
Numerals only (example: 5152453783)  
Student Cell Phone:  
Numerals Only (example: 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). Note: The World Food Prize Foundation will submit all papers to iThenticate, a plagiarism detection service, to protect the integrity of your student's original work.  
(doc,docx)
Student Year in School: *
As of Fall 2015  
Freshman
Sophomore
Junior
Senior
Check the boxes of organizations student is a member: *
FFA 4-H Science Fair
HOBY Model UN Gifted/Talented
Girl Scouts/Boy Scouts RYLA Boys State/Girls State
National Honor Society Student Government Debate or Speech
Mock Trial Journalism None of These
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:  
How did you learn about the Indiana Youth Institute?:  
Categories: Principal, a letter from the World Food Prize, a teacher or past participant, a student, etc.  
 
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