Shodor Main ImageText that says the Shodor Foundation
Current WorkshopProject SUCCEEDWorkshop Archive
CalendarMediaSponsorsFinding Us

Exploration ClassesStudent ProjectsResearch ApprenticeshipsProject SUCCEED-HIInformation Request

Directions: Use this form to be added to our mailing list or to request information. This is not an application form for our programs. If you would like to register for a program, please visit the SUCCEED Calendar of Events.

You can submit this form online by filling in the appropriate information and clicking on the "Submit" button at the bottom of the page, or you can print this form, fill in the information, and fax to (919) 530-1944.

Our mailing lists will not be distributed to any external organization.

Student's Name:

Name of Parent or Legal Guardian:




Zip Code

Daytime Telephone Number

Evening Telephone Number

E-mail (if any)

Would you like to be added to our mailing list?

    Yes, please add me to your newsletter and email mailing lists.
    Please add me to your newsletter mailing list only.
    Please add me to your email mailing list only.
    No, I do not want to be added to either of your mailing lists.

Grade of student (if you are a home school student, estimate an approximate grade level):
    5 6 7 8 9 10 11 12

Age of student:
    10 11 12 13 14 15 16 17 18

Check all of the subject areas that might be of interest to you:
Biology Humanities Geometry
Chemistry Engineering Algebra II/ Trig
Physics Computer Science Pre-Calculus
Meteorology Marine Biology Calculus
Cosmology Discrete Math Statistics
Environmental Science Pre-Algebra Medicine/Biomedical Sciences
Earth Science/Geology Algebra Other (describe below)

I'm interested in learning more about:

How did you hear about the program?

Additional comments or questions:

[ SUCCEED Explorations | SUCCEED Calendar | SUCCEED Home]
[ SUCCEED-HI (For the Hearing Impaired) ]
[ Research Apprenticeships | Completed SUCCEED Workshops ]
[ Student Projects | Media | Locating Us | Info Request | Sponsors ]
[ Shodor Home | Shodor Index ]

Last Update:Wednesday, 18-Aug-2004 10:44:17 EDT
Please direct questions and comments about this page to
© Copyright 1997-2001 The Shodor Education Foundation, Inc.