EPIC on the Road - Interest Form
Please choose the option that applies to you
I work with students and want EPIC on the Road to come to my community
I am a student and want EPIC on the Road to come to my school
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Name
First Name
Last Name
Email
example@example.com
School / Organization
City
Grade level of students
Approximately how many students would you like to participate?
What is your Birthday?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your School
Optional / Current or Previous
Race / Ethnicity - you may select more than 1 (optional)
Asian
White
Hispanic or Latino/a/x
Black or African American
Native American or Alaska Native
Native Hawaiian or Pacific Islander
Other
How interested are you in the Electric Vehicle and Clean Technologies Industry?
I don't have any idea at all
I have watched videos online
I have experience
I know this is exactly what I want to do
Other
I'd like to learn about the following:
Electric Vehicle Maintenance and Repair
OSHA-10 Certification
Hydrogen Fuel Cells
Renewable Energy
Solar panel installation
Electric Vehicle Charging Stations
Other
Please write your schools name or organizations name that you would like EPIC on the Road to come out to:
What is the ideal time and day of the week for you to take this class?
Who is the best person at your school for us to contact about bringing EPIC on the Road to your school? (Please include the persons name, email, and official title)
Do you think you'll have any challenges about participating in a course like this? If so, what are they?
Any additional comments or information you would like to share?
Submit
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