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Program Form
1.
Program / Event / Opportunity Title:
2.
Sponsoring Organization:
3.
Description: (75 word limit)
4.
Submission Type (It is important to mark all that apply):
Program
Financial Resource
Conference or Event
Organization
Other STEM Resource
5.
Target Audience:
K-6th Grade
7-8th Grade
9-12th Grade
Undergraduate Students
Graduate Students
Females
Underrepresented Minorities - includes all of the following groups:
Native Americans
Hispanic Americans
Blacks or African Americans
Asian Americans/Pacific Islanders
Native Americans - specifically
Hispanic Americans - specifically
Blacks or African Americans - specifically
Asian American/Pacific Islanders - specifically
Low-Income and/or First-Generation College Students
Persons with Disabilities
Community
Other (Please Specify)
6.
Specific Eligibility Criteria (if applicable - 25 word limit):
7. Event Date
Ongoing event
Contact program about event date
Season:
Any
Summer (June – August)
Fall (September – November)
Winter (December – February)
Spring (March – May)
Event Start Date:
Event End Date:
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Feb
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Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
2013
2014
2015
2016
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
2013
2014
2015
2016
8.
Length of Event:
9.
Location of Program/Event (if applicable):
Select a city
To be determined
Aberdeen
Acequia
American Falls
Ammon
Arco
Ashton
Bancroft
Banks
Bellevue
Blackfoot
Blanchard
Boise
Bonners Ferry
Bruneau
Buhl
Burley
Caldwell
Cambridge
Carey
Carmen
Cascade
Challis
Chubbuck
Coeur d' Alene
Cottonwood
Council
Dietrich
Downey
Driggs
Dubois
Eagle
Elk City
Elk River
Emmett
Enaville
Fairfield
Featherville
Franklin
Fruitland
Garden City
Garden Valley
Genesee
Glenns Ferry
Gooding
Grace
Grandjean
Grangeville
Hagerman
Hailey
Hansen
Harrison
Hauser
Hayden
Headquarters
Heyburn
Hidden Springs
Hollister
Horseshoe Bend
Idaho City
Idaho Falls
Island Park
Jerome
Jordan Valley
Juliaetta
Kamiah
Kellogg
Ketchum
Kimberly
Kooskia
Kuna
Lake Pend Oreille
Lapwai
Lava Hot Springs
Lewiston
Lowell
Lowman
Mackay
Malad
Malta
Marsing
McCall
McCammon
Melba
Meridian
Middleton
Minidok
Montpelier
Moscow
Mountain Home
Mullan
Murphy
Murray
Nampa
New Meadows
New Plymouth
Nezperce
Oakley
Orofino
Payette
Peck
Picabo
Pierce
Pine
Pinehurst
Plummer
Plummer
Pocatello
Post Falls
Potlatch
Preston
Prichard
Priest River
Rathdrum
Rexburg
Richfield
Rigby
Riggins
Rupert
Salmon
Sandpoint
Shelley
Shoshone
Silver City
Soda Springs
St. Anthony
St. Maries
Stanley
Star
Stites
Sugar City
Sun Valley
Swan Valley
To be determined
Twin Falls
Victor
Warm Lake
Weippe
Weiser
Wendell
Whitebird
Wilder
10.
College or University Affiliation (if applicable):
Select an institution
Boise State University
College of Southern Idaho
College of Western Idaho
Eastern Idaho Technical College
Idaho State University
Lewis-Clark State College
North Idaho College
Treasure Valley Math and Science Center
University of Idaho
University of Idaho, Boise
11.
Other Location Information:
12.
Cost to Attend – registration fee, etc. (if applicable):
13.
Award Stipend Amount to Student (if applicable):
Contact Information
14.
First Name:
15.
Last Name:
16.
Address 1:
17.
Address 2:
18.
Phone:
19.
Email:
20.
Website:
I agree that I am authorized to submit information on behalf of my program/organization. I also understand and agree that this information will be available to the public and that my contact information may be shared publicly to promote STEM education opportunities. I also understand that this website is intended for Idaho STEM-related programs, events, resources, and opportunities and Idaho STEM Pipeline staff are not obligated to post any submissions to the directory that do not align with the programs goals and objectives.
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