Institutional Membership Sign-Up
Welcome to the STEM Fellowship Institutional Memberships Registration! Given that it is a new addition to STEM Fellowship, we are welcoming high schools across Canada to pilot the program with us.

For this registration form, we require the contact information of a supporting school staff supervisor or staff librarian who will be willing to supervise and support the chapter at your school. We suggest the staff supervisor fill out the form and process the transaction through the Paypal payment system.

Failure to complete any of the required information or entering any illegible entries will result in delays in the registration process.

Name of Institution *
Your answer
Address *
Your answer
City of Educational Institution *
Your answer
Province *
Your answer
Phone number of Institution *
Your answer
Institutional Website Link
Your answer
First name *
Your answer
Last name *
Your answer
Job Title
Your answer
Email Address Contact *
Your answer
Alternate email address:
Your answer
Phone number *
Your answer
If providing school number, please provide the extension.
Skype ID *
Your answer
PayPal Confirmation Code *
Your answer
How did you hear about STEM Fellowship’s Memberships Program? *
Your answer
Do you have any STEM Fellowship ambassadors present at your institution? *
Do you have any nominations for students or any student interest in wanting to start a STEM Fellowship chapter? *
Required
If you have any nominations for students, please provide the student's or students' contact information (Name (first, last) and email). Please note that we will accept a maximum of 2 student nominees for leading the chapter.
Your answer
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