An Introduction to Liberatory STEAM Education Registration
1.
First Name
2.
Last Name
3.
Email
4.
Education Institution Type
School District
Charter School
Private School
Community Center/Non Profits
Higher Education/foundation/Government agency etc.
Other (please specify)
5.
School City, State and Zipcode
6.
What grade do you currently teach?
Elementary
Middle School
High School
Graduate School
Other (please specify)
7.
What course do you currently teach?
8.
Which category best describes you?
White (Eg: German, Irish, English, Italian, Polish, French, etc)
Hispanic, Latino or Spanish origin (Eg: Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc)
Black or African American (Eg: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc)
Asian (Eg: Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc)
American Indian or Alaska Native(Eg: Navajo nation, Blackfeet tribe, Mayan, Aztec, Native Village or Barrow Inupiat Traditional Government, Nome Eskimo Community, etc)
Middle Eastern or North African (Eg: Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc)
Native Hawaiian or Other Pacific Islander (Eg: Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, etc)
Some other race, ethnicity or origin
Other (please specify)
9.
Gender
Women
Man
Gender Fluid
Genderqueer
Agender
Non Binary
Unsure
Prefer Not to say
Other (please specify)
10.
I confirm that I will attend both sessions on April 25 and May 2nd from 4 to 5:30 pm.
Yes
No