The Great American Energy Debate

Please fill out the following information to register for The National Student  Energy Survey.

Teacher First Name   Last Name 

School Name          

School Address     

     City         State         -- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip

Telephone       Best Times to Call

Email             

  Our school will participate in The National Student Energy Survey before March 19, 2010.

What Grade Levels? Please check all that apply. 

Below 7 7^th    8^th    9^th   10^th   11^th   12^th

Approximately how many students?

Do you wish to survey adults in the community? Yes        No

If surveying adults, approximately how many?   

 Are participants taking the survey as a specific club or group?  Please check  

 one of the groups below if it applies.

FCCLA Member:              Yes

SkillsUSA Member:          Yes

Student Council Member:      Yes     

NJHS/NHS Member        Yes