PSEG Long Island - I Am EM-Powered Program & Student Challenge
Program Registration Form
What is your role?
School Name (only answer if you are a teacher)
School Street Address
Town, State, Zip
School Phone and Extension
Cell Phone Number
Please enter a valid phone number.
School Affiliated E-mail address
What grade level will you use program?
How many of your classes will participate in this program?
How many students will be participating (based on your number of classes participating)?
What is the best way to contact you?
Text Message to Cell Phone (please be sure to include your cell phone number above)
Comments or Questions
Should be Empty: