STEM Career Showcase for Students with Disabilities Registration Form - Individual
Name of School or Group
Chaperone Cell Phone Number (in case of emergency)
Additional Chaperones' Names
Please list any accommodations needed (ex. wheelchair, noise-canceling headphones, assistive listening devices, blind-deaf interpreter, etc.).
How did you hear about the STEM Career Showcase for Students with Disabilities?
Photo/Video Release Consent
Should be Empty: