Student Pre-Long Engagement Survey- Beckley Site
To be filled out by students (4th-12th grade) prior to beginning long term  classes.

Please know in advanced that we thank you for completing this form. The data collected is used in evaluation processes for funding purposes.  It also assists staff in providing quality educational programs. No identifying information is collected.

WVSU R & D is an Equal Opportunity/Affirmative Action Employer and does not discriminate against any person because of race, sex, age, color, religion, national origin or disabilities.
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Date
MM
/
DD
/
YYYY
You are particpating in this activity: *
Check the answer that applies best
Where are you attending this activity: *
Name the school and/or location
What grade are you currently in: *
Which other NASA/STEM (science, technology, engineering and mathematics) programs or events have you previously particpated?   *
Check all that apply
Required
What of these NASA/STEM programs would you like to participate in?   *
Check all that apply
Required
What do you hope to gain from this experience? *
Check all that apply
Required
I am interested in *
Check all that apply
Required
I know alot about: *
Check all that apply
Required
I am good at: *
Check all that apply
Required
I am interested in the following career choices: *
Check all that apply
Required
My family is interested in: *
Check all that apply
Required
NASA STEM After School Programs/Clubs *
Check the answer that applies best
What is your Gender?
Clear selection
What is your Ethnicity?
Clear selection
What is your Race?
Clear selection
Disability Status?
Select one or more
Submit
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