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PSEG Long Island - I Am EM-Powered Program & Student Challenge
Program Registration Form
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What is your role? *
First & Last Name *
County *
School District *
School Name (only answer if you are a teacher)
School Street Address *
Town, State, Zip *
School Phone and Extension *
Cell Phone
School Affiliated Email Address *
What grade level will you use program? *
How many of your classes will participate in this program? *
How many students will be participating (based on your number of classes participating)? *
What is the best way to contact you?
Comments or questions?
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