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Student Registration Form - Michigan

Teachers: Please complete the Student Registration & Paper Submission Form below by inputting your student's information and uploading their research paper. A separate form must be submitted for each participating student. The form is simpler to complete when submitting with the student present.

Registrations are due by April 8, 2016 to participate in the 2016 World Food Prize Michigan Youth Institute at the Michigan State University 

Once you have submitted your online forms, Makena Schultz or Brian Wibby, the Michigan State Coordinators, will confirm your registration.

If you have any questions or need assistance, please contact the Michigan State Coordinators: Makena Schultz at schul430@anr.msu.edu or (517) 432-7603 and Brian Wibby at wibby@anr.msu.edu or (906) 475-5731.

NOTE: To enroll in the optional Mentor Program, please fill the Student Registration form by March 1, 2016. Paper Submission does not need to be filled until April 8, 2016.

* denotes a required field.
School Name: *
School City: *
Teacher/Mentor First Name: *
Teacher/Mentor Last Name: *
Student First Name: *
Student Last Name: *
Student Ethnicity/Race: *
Select all that apply. Information collected is only used for statistical purposes.  
Student Gender: *
Select all that apply.  
Student Home Email: *
Student School Email: *
Preferred Email Address: *
Please indicate which email you most frequently use throughout the year  
Student Cell Phone:  
Numerals Only (example: 5152453783)  
Student Home Phone: *
Numerals only (example: 5152453783)  
Student Preferred Phone: *
Student Twitter:  
Twitter Handle (example: @thenextnorm)  
Student Home Address: *
Student City: *
Student State: *
Use State Acronym (ex: IA, MN, OH, NY)  
Student Postal Code: *
High School Graduation Year: *
Check the boxes of organizations student is a member:  
Other Organizations:  
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 Paper: Countries: *
Student focused on which country?  
Student Paper: Factor: *
Student focused on which global food security challenge?  
Student Areas of Interest: *
Select all that apply. Areas of Interest are collected to shape future programming and marketing.  
How did student learn about this opportunity?: *
Select all that apply  
Other Source:  
If not included in list, describe source of information.  
T-Shirt Size: *
Please choose your t-shirt size preference  
Dietary Restrictions: *
Please indicate any dietary restrictions  
Accessibility Needs: *
Please indicate any accessibility needs  

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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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