2023-2024 Black Rocket Interest Form

2023-2024

Black Rocket Interest Form

Form Date Field

Last Name*

First Name *

Email*

Confirm Email Address *

School/Site*

Select

School Address *

Site Director Name*

Program Manager Name*

STEM Staffing

Are you interested in hiring a Black Rocket Staff to deliver STEM curriculum at your site?

Note, the clearance time for Black Rocket staff may delay the program start date.

Do you currently have a New York Edge STEM Specialist who can deliver the Black Rocket STEM curriculum?

Select or enter value

If you indicated that you do have a STEM Specialist to deliever the Black Rocket curriculum, please list the name(s) and email(s) of the STEM Specialist

Technology

What type of computers do students use at your site?*

Select or enter value

How many computers do you have for each type identified above?

Example:

Windows PC - 20 computers

Mac - 5 computers

Is there a firewall at your site?

Select or enter value

If you answered yes, there is a firewall, which websites are currently blocked?

Who troubleshoots tech issues at your site? Please include their full name and email address.

BlackRocket STEM Course Information

Total number of students anticipated to participate.

Number of groups

Example: 3 groups of 30

Tentative Start Date

Scheduled Days

Select

Scheduled Time

Questions & Feedback

Send me a copy of my responses

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