NASA JSC Space Day Registration

NASA Johnson Space Center
Office of Education
Space Day Registration Form
Please note the time you begin. Upon completion, we will ask you to let us how much time it
took you to complete this form.
Privacy Policy Information collected on this website is for a NASA Office of Education Project.
This notice provides NASA's policy regarding the nature, purpose, use and sharing of any
information collected via this Web site. The information you provided on a NASA Web site will
be used only for its intended purpose. We will protect your information consistent with the
principles of the Privacy Act, the e-Government act of 2002, the Federal Records Act, and as
applicable, the Freedom of Information Act.
Submitting information is strictly voluntary. By doing so, you are giving NASA your permission
to use the information for the intended purpose. If you do not want to give NASA permission to
use your information, simply do not provide it. However, not providing certain information may
result in NASA's inability to provide you with the information or services you desire.
View Full NASA Privacy Policy
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2
of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we
display a valid Office of Management and Budget (OMB) control number. The OMB control
number for this collection is 2700-0153 and expires on 06/30/2014. We estimate that it will take
10 minutes to read the instructions, gather the facts, and answer the questions. Send only
comments relating to our time estimate to: HQ-OEIDAdmin1@mail.nasa.gov
Educational Organization Name: ________________________________________________
Educational Organization Street: ________________________________________________
Educational Organization City:

________________________________________________

Educational Organization State:

________________________________________________

Educational Organization Zip:

________________________________________________

Educational Point of Contact (POC) Name: __________________________________________
Educational POC Work Email: ________________________________________________
Educational POC Work Phone Number:___________________________________________
Educational POC Work Fax Number: __________________________________________

Educational POC Work Cell Number: ____________________________________________
Grade level of student attendees: ________________________________________________
Number of Student Attendees: ________________________________________________
Number of Chaperones: ________________________________________________
Anticipated Arrival Time ________________________________________________
I’m interested in receiving other NASA opportunity announcements. ____Yes ____No
Upon submission of this form, you will receive notification it has been received and at a later
date will be notified of your acceptance to participate.
Please complete the following questions.
Please let us know how long it took you to complete this form. :_______min ____hours
Our goal is to provide a registration form that is easy to understand. On a scale of 1 – 5 with 5
being the highest, please indicate how easy it was to understand and complete the Space Day
registration form: 1 2 3 4 5
Do you have any suggestions to make this registration form easier to understand/ complete? If
yes, please let us know: ________ (500 character limit)