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WFP Arkansas Youth Institute Registration Form

Please complete the online registration form for your student by April 1, 2014, for the 2014 World Food Prize Arkansas Youth Institute. Due to space limitations, registration does not guarantee participation.

Once you have submitted your form online, Chris Bacchus, the Arkansas State Coordinator, will review it and officially confirm your registration.

* denotes a required field.
School Name: *
School Address: *
School City: *
School State: *
Use State Acronym only (example: IA, MN, OH, NY)  
School Postal Code: *
Main School Phone: *
Numerals Only (ex: 5152453783)  
School Fax:  
Numerals Only (ex: 5152453785)  
Principal/Administrator Prefix: *
Principal/Administrator First Name: *
Principal/Administrator Last Name: *
Teacher/Mentor Prefix: *
Teacher/Mentor First Name: *
Teacher/Mentor Last Name: *
Teacher's Discipline: *
Courses taught (biology, ag ed, history  
Teacher/Mentor Gender: *
Select all that apply.  
Teacher/Mentor Work E-mail: *
Teacher/Mentor 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.  
Student Home Email: *
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 2016  
Check the boxes of organizations student is a member:  
Is the student's GPA 3.25 or higher?: *
Local Newspaper Name: *
Local Newspaper E-mail:  
Other Local Media Name:  
Other Local Media E-mail:  
How did you learn about the Arkansas Youth Institute?:  
Categories: Principal, a letter from the World Food Prize, a teacher or past participant, a student, etc.  

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Contact World Food Prize

100 Locust Street
Des Moines, Iowa 50309 USA

Phone: +1 515-245-3783+1 515-245-3783

Fax: +1 515-245-3785

wfpf@worldfoodprize.org
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