Questions marked with an * are required
 
 
Use this form to pre-register for a remote session during the "America Looks Into The Nano World Open House," taking place on Monday October 9th at 1PM EDT in celebration of National Nanotechnology Day. Thank you for your interest.
 
 
 
* First Name : 
* Last Name : 
* Email Address : 
 
 
* Institution :
   
* Phone :
   
* City :
   
* State :
   
* Zip :
   
* Country :
   
 
 
* Institution Type:
 
Middle school
 
High school
 
Technical high school
 
2 year college
 
4 year college
 
Other
    
 
 
 
* Approximately how many students will participate?
 
5 or less
 
5 to 10
 
10 to 20
 
20 to 25
 
More than 25
 
 
 
Which grade levels will participate in the remote session? (Check all that apply)
 
K- 8th
 
9th - 10th
 
11th - 12th
 
Undergraduate
 
Graduate student

 
 
 
Do you currently offer a nanotechnology course at your institution/organization?
 
Yes
 
No
 
 
 
Did you install the Zoom video conferencing software onto the computer you are using for the remote session?
 
Yes
 
No, it will be installed before the remote session
 
No, I would like help downloading and installing the software
 
No, I cannot download that software. Please suggest an alternative system.
 
 
 
* What type of samples would like to image during remote access? (Check all the apply)
 
Synthetic Nanomaterials (nanoparticles, nanowires, etc.)
 
Biological Nanostructures (butterfly wing, gecko skin, cicada, etc.)
 
Electronics (microchip, DVD, Blue-Ray, etc.)

 
 
 
Briefly describe your learning objective(s) for the remote activity:
   
 
 
 
Would you care to provide any additional details on student background, curriculum or how you hope to implement the RAIN opportunity into your event?
   
 
 
 
I agree to complete a post remote session surveys (Instructors and Students/Attendees) to help the RAIN program as part of NACK Network’s NFS grant funding responsibility to report their outreach and educational efforts