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Academic Community Exercise Starter Kit Request Form

Fill out the below information to request an Exercise Starter Kit(s) and sign up for the Office of Academic Engagement's (OAE) monthly newsletter. 
1.Name(Required.)
2.E-mail Address(Required.)
3.Name of School or School District (Full Name, No Abbreviations Please)(Required.)
4.Location (State or Territory) of School or School District(Required.)
5.What is your Role at your School or School District?(Required.)
6.Requested Higher Education Focused Exercise Starter Kit(s):(Required.)
7.Optional: Requested K-12 Focused Active Shooter Exercise Starter Kit(s):
8.Subscribe to DHS Academic Engagement Monthly Newsletter?(Required.)
DHS Privacy Notice
Office of Academic Engagement Privacy Notice
This Privacy Notice serves to inform you of why DHS is requesting the information on this form.
AUTHORITY:
DHS is authorized to collect the information requested on this form pursuant to 5 U.S.C. 301 and 44 U.S.C. 3101.
PURPOSE:
DHS is requesting this information for the purpose of contacting you after you register for an event.
ROUTINE USES:
The information requested on this form may be shared externally as a “routine use” to other agencies to assist DHS in allowing you to participate in events you have registered for. For individuals covered by the Privacy Act, a complete list of the routine uses can be found in the system of records notice associated with this form, “DHS/ALL-002 Mailing and Other Lists System.” The Department’s full list of system of records notices can be found at http://www.dhs.gov/system-records-notices-sorns.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION:
Providing this information to is voluntary. However, failure to provide this information may result in you not being able to attend the event.
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