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School Registration Intake Form

Contact Information

First Name

Last Name

Phone Number

Title

Department

Are you our primary contact at your Institution?

If not, please provide the name and email address for the primary contact.

Institution Information

Institution Name

Address 1

Adress 2

County

Institution Type

Institution Category

How many students does your Institution serve annually?

Education Program Information

What STEM programs do you offer?

How many STEM educators are at your Institution??

Do you have any teachers?

Are there any other additional team members in your department?

Do you have a school or teacher on-site?

If yes, please tell us a bit more about your school program offering. g. Are students included in your planning process?

If so, what does that inclusion look like?

What are the main challenges facing your STEM program?

Institution Demographic Information

Please share a bit about the unique demographics of the student you serve.

Please list the top 3 racial and ethnic groups served by your Institution.

Demographic

White Hispanic and Latino Black or African American Asian Two or more races Native American or Alaska Native Native Hawaiian or Other Pacific Islander

What percentage of students that you serve are at or below the poverty level?

The National Cryptologic Foundation (NCF) Program Information

Which NCF programs are currently active (or recently received) at your Institution?

Programs

Cyber Chats Outreach Portable Escape Room Cyber Security Curriculum Guidelines Virtual Gaming On-site Field Trips Virtual field trips of the Cryptologic Museum On average, how many students each day benefit from NCF programs?

Additional Contacts

Please provide a contact in each of the below departments for our records. *We will not reach out to these contacts without including you. i. Development/Foundation

Stories to Share

NCF needs to hear from you!
Without your stories we can’t advocate for you and share the incredible work you are doing each day with our network of supporters.

Please share any stories about our programs and the impact they have had on your students and staff.

Questions, Comments, Etc.?

For example, are there any programs you wished NCF offered that we currently don’t? Would you like us to contact you directly to share more about our programming? Do you have any stories of students experiencing improved academic success and/or interest?

Questions, Comments, Etc.?