NFB STEM2U Application | National Federation of the Blind

Thank you for your interest in the NFB STEM2U program. Please complete the following application form. If you have any questions, please email [email protected].

Note: All fields with an asterisk (*) are required.

Program Selection

Please select the program you wish to attend. *

Student Information

Student First Name *

Student Last Name *

Student Gender *

Student Birth Date *

Student's current grade level (K through 12th) *

Student Email *

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Address Line 1 *

Parent/Guardian Address Line 2 - Optional

Parent/Guardian City *

Parent/Guardian State *

Parent/Guardian Zip Code *

Parent/Guardian Email *

Parent/Guardian Primary Phone *

Parent/Guardian Phone Type *

What is the primary language spoken at home? *

TBS (Teacher of Blind Students) Information

Student's TBS First Name - Optional

Student's TBS Last Name - Optional

Student's TBS Primary Phone Number - Optional

Student's TBS Email - Optional

Additional Information

Is the student currently enrolled in school or home schooled in the United States? *

Describe your student’s experiences in STEM (Science, Technology, Engineering, and Math), if any.* - Optional

Is there any other information about your student you would like to share? - Optional

NFB STEM2U pursues grant funding to support the programs, and some of these grantors ask us to describe the racial/ethnic/socioeconomic backgrounds of our students. In order to improve our program delivery and to respond to these requests, we ask you to answer the following questions.

What is the approximate average annual household income for the child's primary residence? *

Permission Release

The NFB affiliate of your state often takes photographs and video of participants and adult participants for educational and promotional purposes during the NFB STEM2U program. Those participating in the e-learning option may also email us media of participants engaging in experiments at home. Do you give permission for the National Federation of the Blind to use your and/or your child’s image or likeness in materials produced by the NFB for promotional and educational purposes or for any other purpose and in any manner and medium, including, but not limited to, the following: print materials, websites, social media and news media? *

I give permission for my child to participate in the National Federation of the Blind (NFB) STEM2U events and activities. I have read and understand the questions and information on this registration form, and have answered the questions truthfully to the best of my knowledge. *

Do you want to to be inform of other youth activities in your state? - Optional

Upon submitting this form your responses will be saved, and you will receive an email copy of your responses. For additional questions or concerns please contact Ashleigh Moon at [email protected] or by phone at 410-659-9314, extension 2418.