Mini-Mission Registration Step 1

Lead Instructor Name *

First

Last

Lead Instructor Email *

Lead Instructor Phone *

Mailing Address for loanded supplies (we prefer an organization if possible over a residential address) *

Address Line 1

Address Line 2

City

State

Zip Code

Will you have an assistant instructor? *

Yes
No

Assistant Instructor Name (Optional)

First

Last

Assistant Instructor Email *

Assistant Instructor Phone *

Shipping Address for Supplies *

Address Line 1

Address Line 2

City

State

Zip Code

Which mini-mission will you lead? *

Please describe your anticipated mini-mission. Include information on how you plan to recruit students and whether you are part of an organization (like GEAR-UP or the Boys and Girls club). *

How many students do you estimate will attend your mini-mission? *

City, State of mini-mission *

What is the zip code of the location of your mini-mission?

Where, specifically, do you plan to hold your mini-mission (e.g. I will hold the mini-mission at Sally Ride Middle School.)? *

Please confirm that you agree to complete a mini-misson training, a background check (if required), and will submit information on needed supplies at least 2-weeks before the start of your mini-mission.

Please upload a signed Instructor Agreement Form as a word document or pdf *

Click or drag a file to this area to upload.

Mini-Mission Registration Step 1

Announcements