2025 Ohio Youth Institute Adult Registration Form

2025 Ohio Youth Institute

Adult Registration Form

Contact Information

Email Address*

Please enter your email below to receive a confirmation message upon the completion of your registration.

Your Prefix

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Your First Name*

Your Last Name*

Your Office Phone Number

Numbers only, no punctuation. (Example: 5552551000)

Your Cell/Mobile Phone Number*

Numbers only, no punctuation. (Example: 5552551000)

Preferred Contact Method*

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Your Discipline*

Select all teaching fields that apply. Choose "Parent/Guardian" if the student's parent/guardian is serving as mentor.

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Emergency Contact - Name

In case of emergency who should we contact?

Emergency Contact - Relation to Mentor/Chaperone

Example: Spouse, Significant Other, Mother, Father, Sibling, etc.

Emergency Contact - Phone Number

Numbers only, no punctuation. (Example: 5552551000)

School/Organization Information

School/Organization Full Name

Example: Roosevelt High School

School Address

School/Organization City

School/Organization State

School/Organization Zip Code

School/Organization County

Main School/Organization Phone

Numbers only, no punctuation. (Example: 5552551000)

Global Challenge Student Engagement*

In total, how many students in your school/organization did you engage through the World Food Prize Foundation Global Challenge curriculum?

Include the number of students in your school/club that wrote a paper and/or participated in some other way through the Global Challenge curriculum (poster presentation, hunger banquet, food drive, discussion on global food security issues).

Global Challenge Student Support*

What type of support did you provide to students? (e.g., research guidance, paper editing, etc.)

Information for Ohio Youth Institute

Please indicate your level of participation for the Youth Institute.*

A chaperone is who will be bringing the student to the event and will also attend the event in person.

A mentor, on the other hand, helps students with their Global Challenge Research Paper, supporting the student while writing the Global Challenge research paper.

Some people may choose to be both a chaperone and a mentor, helping with both the event and the research. When you register, you can let us know if you’ll be a chaperone, a mentor, or both.

Yes, I am attending the event as a Chaperone.

Yes, I am attending the event as both a Chaperone and a Mentor for the Global Challenge Research Paper.

No, I am only helping a student/s with their Global Challenge Research Paper

Accompanying Chaperone Information*

If you are unable to attend, please provide the name and contact information of the individual who will be accompanying the student/s at the Youth Institute.

Planned Student Attendance*

How many students do you plan to bring? List the names of the student/s you are traveling with.

Your Dietary Restrictions

Please indicate if the student has any dietary restrictions. Some examples may include vegetarian, vegan, food allergies, etc. If there are none, please state "None" as your answer.

Your Medical/Health Information

Please indicate if any special accommodations are needed. If you need special assistance for mobility reasons (wheel chair, signers, etc.) during the Iowa Youth Institute, let us know at this time. We are happy to help. If there are none, please state "None" as your answer.

How did you hear about the Youth Institute?

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By checking below, I agree to ensure the attendance and participation of my student/s in the Ohio Youth Institute, on April 14, 2025 at The Ohio State University.**

By checking below, I guarantee if for any reason I am unable to participate in the Youth Institute, I will ensure my student is supported, either with another teacher/mentor or by working with my student ahead of time to ensure their participation.

Send me a copy of my responses

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