ORISE 30th Anniversary Competition

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ORISE 30th Anniversary Competition

Thank you in your interest in our ORISE 30th Anniversary K-12 Teacher Competition. Only teachers who teach in the U.S., U.S. territories, or DoDEA schools are eligible. Teachers may win 2 times in a 12 month period. If you have any questions, please contact STEMEd@orau.org.

Tell us about you

First Name:	First Name:
Middle Name:	Middle Name:
Last Name:	Last Name:
Grade Level:	Grade Level:
School:	School:
City of School:	City of School:
Home Address:	Home Address:
City:	City:
State:	State:
Zip Code:	Zip Code:
E-mail:	E-mail:
School Email:	School Email:
Phone Number:	Phone Number:

How did you hear about this contest?

The following demographic data is used only for ORISE program participant reporting.

Are you a U.S. Citizen?

Yes

Prefer not to answer

What is your country of citizenship?

Gender

Race/Ethnicity

I give permission to ORAU and its agents to use in connection with any publication (including but not limited to brochures, Web sites, booklets, reports, press releases, and exhibits) the photograph(s) video or audio productions, or any other files portraying my image or likeness in association with ORAU in which I appear. This also applies to any photos/media, documents, or other submissions voluntarily provided. ORAU will maintain possession of all associated negatives, digital, video, and/or audio files, film, CDs, photographic prints, etc.; and will maintain video, and/or audio files, film, CDs, photographic prints, etc.; and will maintain all rights to these images and other files; and may use, at our sole discretion and for a period of time determined by us, in future materials.

I give permission for my images to be published.

I do NOT give permission for my images to be published.

What item would you like to receive in your classroom?

Please enter the name of the item and provide the link to that item.

Name of Item	Name of Item
Link to Item	Link to Item
Quantity of Item	Quantity of Item

Please select ONE prize level for us to order a piece of equipment to replace current equipment in your classroom.

Prize level should indicate the cost of the replacement item without taxes or shipping.

$1000.00 prize

$750.00 prize

$500.00 prize

$250.00 prize

Please attach or insert the link for your video below.

Video Upload

Insert url here if sharing via link.

By typing your name you certify that your work is original and understand that if it is copyrighted you may not be eligible to win future competitions.

Name

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