Mini-Mission Registration Step 2

Lead Instructor Name *

First

Last

Lead Instructor Email *

Lead Instructor Phone *

Which mini-mission will you lead? *

We can offer additional training sessions for instructors that cannot attend the trainings above or need additional help. If you would like to request an additional training session, please describe your needs (e.g. which parts of the lessons would you like help with).

Please list and describe, if necessary, the organization were you will hold this Mini-Mission *

Please provide the address for the organization where you will hold this mini-mission *

Address Line 1

Address Line 2

City

State

Zip Code

Does this organization cover insurance and liability for participants of your mini-mission? *

Yes
No
I'm not sure

What is the starting date of your mini-mission? *

What is the ending date of your mini-mission? *

Please upload the Student Information Spreadsheet: *

Click or drag a file to this area to upload.

Please upload a schedule that describes the dates and times of your mini-mission and a short description of the planned activities *

Click or drag a file to this area to upload.

Would you like to request extra support, such as help running the scholarship session, a college student panel, or teaching assistant support? If you want NESSP to virtually visit your event, please give specific dates and times

Will you be requesting a stipend for a lead instructor? *

Yes
No

Note, we are not able to provide stipends or payment of efforts to instructors that are already being paid for this work through another grant or organization.

Please Upload a Signed Lead Instructor W9 Form (Found: https://www.irs.gov/pub/irs-pdf/fw9.pdf) *

Click or drag a file to this area to upload.

Please download, fill out, and upload a W9 form for the lead instructor. Please verify this form includes a complete address, social security number, and signature. Without all these items we will not be able to provide a stipend.

Will you be requesting a stipend for an assistant instructor? *

Yes
No

Note, we are not able to provide stipends or payment of efforts to instructors that are already being paid for this work through another grant or organization.

Please Upload a Signed Assistant Instructor W9 Form (Found: https://www.irs.gov/pub/irs-pdf/fw9.pdf) *

Click or drag a file to this area to upload.

Please download, fill out, and upload a W9 form for the lead instructor. Please verify this form includes a complete address, social security number, and signature. Without all these items we will not be able to provide a stipend.

Mini-Mission Registration Step 2

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