DSEC SeaPerch Post-Event Demographic
Please fill out this form with the demographic data of those that participated in your SeaPerch event.
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
What region are you located?
Please Select
Louisiana Region 1
Louisiana Region 2
Louisiana Region 3
Louisiana Region 4
Louisiana Region 5
Louisiana Region 6
Louisiana Region 7
Louisiana Region 8
Louisiana Region 9
Texas - San Antonio
Texas - Killeen
Virginia
Organization or School partnered with RoboNation
*
Kit Batch number*.
Please Refer to the number the RoboNation Assigned to your order.
How many SeaPerch Kits were Distributed or used in the event being reported.
Each Kit should serve 4-5 participants.
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Program Information
Program or Event Name
*
(Classroom Activity, Summer Camp, Afterschool Club, Teacher Training, etc.)
Location of SeaPerch Event or Program
*
Zip Code
What Month Did this Event or Program Begin
January
February
March
April
May
June
July
August
September
October
November
December
What type of participants participated in your SeaPerch event
*
Students
Educators - adults that have been trained in the SeaPerch program
Volunteers - adults that helped implement the program but have not been trained
Which method did you use to calculate the number of participants
*
Registration Information
Inference from classroom counts/demographics
Actual headcount
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Student Information
How many students had direct student participation?
*
Please provide the count of students in each applicable category below.
Age 12 and under
Age 13 and over
Student Grade information (Please provide the count of students in each applicable category below.)
*
12 and under
13 and over
Grades K - 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
2-Year and/or Tech College Undergraduates
4-Year College Undergraduates
Graduates (Master's, Doctoral Candidates)
Not in School
Student Demographic Information (Please provide the count of students in each applicable category below.)
*
12 and under
13 and over
Hispanic or Latino/a/x
Asian
Black or African American
White
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
Middle Eastern or North African
Multi-racial
Prefer not to say
Student Genders (Please provide the count of students in each applicable category below.)
*
12 and under
13 and over
Female
Male
Non-Binary
Prefer Not to Say
Additional Genders
Did this event serve military-connected students?
*
Please Select
yes
no
If you served military-connected students, how many participated in your event?
*
Were any postsecondary students served?
Please Select
yes
no
Were there any direct military-connected students served in this program? If so, please fill in the numbers that apply.
*
Please provide the count of students in each applicable category below.
Currently enlisted and on active duty
Military Veteran
National Guard or Reserves
Working for the military as a civilian
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Educator Information
Educators are defined as any adult that has been trained by the DSEC SeaPerch program
How many educators had direct participation?
*
Educator Position Information
*
Please provide the count of educators in each applicable category below.
Teacher
School Administrator
Counselor
District Administrator or Staff
Other
If you had any listed under "other", please list the positions.
Educator Genders
*
Please provide the count of educators in each applicable category below.
Female
Male
Non-Binary
Prefer Not to Say
Additional Genders
Educator Demographic Information
*
Please provide the count of educators in each applicable category below.
Hispanic or Latino/a/x
Asian
Black or African American
White
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
Middle Eastern or North African
Multi-racial
Prefer not to say
Please enter the number of educators who teach in a military-connected school.
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Volunteer Information
Volunteers are defined as any adult that helps to implement the SeaPerch program but has NOT been trained.
Relationship to Program
*
Please provide the count of volunteers in each applicable category below.
Alumni of the program
DoD STEM personnel
Parent/guardian of a participant
Education partner (teacher, coach, etc.)
Community Member
Mentor
Team Sponsor
Other
Other relationships: Please enter the types of other relationships not listed above.
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