Eisenhower Regional Consortium for Mathematics and Science Education at AEL

Registration Form

 

Thank you for your interest in the Graphing Calculators. Please take a few moments to complete the following form. This information is necessary for Consortium evaluation purposes.

Is this the first time you have received a product from the Consortium?
Ethnicity:      Other:
Gender:    
Select the one category below that most closely describes your current position.
Federal agency/level
State education agency/level
Intermediate education agency/level
Institution of higher education
Professional association
School district/building*
Eisenhower National Clearinghouse/
Consortia
Regional service providers
National Science Foundation
(SSI/USI/RSI/LSC)
Information science
Community and/or parents
Parent or parent association member
Business/industry
State association or council staff
Other   

*If "School district/building," please (1) indicate your role; (2) indicate whether you are providing information about your school or district; (3) provide your school or district level, setting, and at-risk status.

Role   Providing   Level   Setting   At-Risk Status  

If you would like to provide contact information, we will add you to our participant database, which will allow us to contact you in the future to hear how you have used this resource. All information is strictly confidential and will be used for internal reporting only. Thank you for your cooperation.

Contact Information (optional)
Name:
Mailing Address:
City:
State:    Zip:    Phone:
 
District:
County:
School/Organization:
Mailing Address:
City:
State:     Zip:
E-mail Address:
Phone:     Fax:

 

  • Return to Eisenhower Regional Consortium for
    Mathematics and Science Education