100%

Virginia Tech Roanoke Center STEAM Interest Form

Questions marked with a * are required

Contact Information

First Name

Last Name

Email address

Cell Phone

City

Zip Code

Best way to contact you

Phone

Email

Are you requesting programs as a

Teacher

Administrator

Parent

Other

Choose your school district

How many students are you signing up?

1-5

6-10

11-24

25+

What grade level(s) are you signing up (Check all that apply)?

grades 3-5

8

11

6

9

12

7

10

Which program(s) are you interested in attending? Please see our website for detailed descriptions.

Qualcomm® Thinkabit Lab™ Signature Experience

A.C.E Engineering Space Adventure

Battle of the Roa-bots

Paper Circuits Lab

Pico Problems

Summer Camp

Other

When are you planning to book your program(s)?

Within the next month

Within the next three months

Within the next six months

More than six months from now

Interested in Summer camp

Teachers, which day of the week would you prefer for school year programs?

Monday

Tuesday

Wednesday

Thursday

Friday

As a follow-up for teachers, are there specific dates you prefer for programming? We will do our best to accommodate your request.

How did you hear about our programs?

Referral from colleague/friend

Online search

Social media

Advertisement

Other

Have any questions? Ask us below and we will get back to you as soon as we can!

Powered by QuestionPro

Loading...

Custom Title