Adult Sign In Form
To be filled out by the adult person participating in the NASA  program/services.  Please know in advance that we thank you for completing this form. The information requested is used in evaluation processes for funding purposes.  It also assists the staff in providing quality educational programs. The Information will be held in the strictest confidence and identifying information will not be disseminated.

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Email *
What type of activity are you participating in? Example:  online training, AEL activity, robotics, electronics, etc? *
Are you a..... *
Last Name *
First Name *
Birth Sex *
Race/Ethnicity/ Gender *
If photographs are taken, I give permission for my photograph to be used in publications or WVSU marketing material without expectation of compensation. *
 West Virginia State University is an equal opportunity affirmative action institution. No person shall be denied admission to educational program, activities or employment on the basis of any legally protected status, or be subjected to prohibited discrimination involving, but not limited to, such factors as race, color, creed, religion, national or ethnic origin, marital status, citizenship, sex, sexual orientation, gender identity or expression, age, disability, or protected veteran status. Upon request, reasonable accommodations will be made to provide this content into an alternate accessible format. Please contact Carla Boggess at (304) 766-4278 or and complaints related to bias or equal opportunity in education and in employment based on aspects of diversity protected under federal, state, and local law, or arising under Title IX should be directed to: Carolyn Stuart, EEO Officer, at (304) 204-4018.Women, minorities, people with disabilities and veterans are encouraged to apply. 
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