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Teacher Registration Form - Kansas

Please complete this online teacher-registration form to register for the 2016 Kansas Youth Institute at Kansas State University.

Registrations are due by March 11, 2016.

NOTE: The student registration form and paper upload is a separate registration form from this teacher registration.

You, the teacher, only need to fill out this form once for yourself. Please remember that you will need to fill out a separate student registration form for each of your students that will participate. Each student's paper is to be uploaded as part of their respective individual registration form.

If you have any questions or need assistance, Sandy can be reached at sandy@ksu.edu or 785-532-5121.

* denotes a required field.
Teacher/Mentor Prefix: *
Teacher/Mentor First Name: *
Teacher/Mentor Last Name: *
Teacher/Mentor Gender: *
Select all that apply.  
Teacher/Mentor Cell Phone: *
Numerals Only (ex: 5152453783)  
Teacher/Mentor Home Phone:  
Numerals Only (ex: 5152453783)  
Teacher/Mentor Preferred Phone: *
Teacher/Mentor Home E-mail: *
Teacher/Mentor Work E-mail:  
Teacher/Mentor Preferred Email: *
Please indicate your preferred email address  
Teacher/Mentor Twitter:  
Teacher Twitter Handle ex: @Janesmith  
Teacher/Mentor Home Address: *
Teacher/Mentor City: *
Teacher/Mentor State: *
Use State Acryonym (ex: IA, MN, OH, NY)  
Teacher/Mentor Postal Code: *
Teacher/Mentor Discipline: *
Select all teaching fields that apply. Choose Parent if the students parent is serving as mentor.  
How many students do you plan to bring to the State Youth Institute?: *
List as numeral (1,7,24,etc.)  
In total, how many students in your school/club were involved?: *
Include the number of students in your school/club that wrote a paper and/or participated in some other way (poster presentation, hunger banquet, food drive)  
How did you learn about this opportunity?: *
Select all that apply  
Other Source:  
If not included in list, describe source of information.  
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 Twitter:  
School Twitter Handle (example: @CentralHSRams)  
Local Newspaper Name: *
Local Newspaper E-mail:  
Other Local Media Name:  
Other Local Media E-mail:  
Accessibility Needs: *
Please indicate any accessibility needs  
Dietary Restrictions: *
Please indicate any dietary restrictions  

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Phone: +1 515-245-3783+1 515-245-3783

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wfpf@worldfoodprize.org
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