NOAA Registration Form

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

NOAA Registration Information
General Registration Information:
    1. Name
    2. Email
    3. Title
    4. School/Organization/Company
    5. Organization Type (Non-Profit, Corporate, Association, etc.)
    6. Industry Sector (Retail, Re/Insurance, Architecture/Engineering)
    7. State/Province
    8. Country
    9. Zip Code
    10. Q&A – Are there any questions or comments you would like to be addressed at the meeting?
    11. Q&A - 
    12. What do you hope to get out of this conference/workshop?
    13. Which days of the conference/workshop are you able to attend?
    14. Optional Opt-In to Email Marketing List
    15. Please share any dietary restrictions (if a meal is provided during the event)

For educational activities/programs:
The application seeks to expand the questions asked at registration to gather more information about attendees’ prior knowledge and motivations to register in order to provide a baseline data point for where attendees are at before attending a workshop and provide helpful information about “who is in the room” to the workshop hosts and facilitators ahead of the event.
    1. What School District(s) do you work with?  (if applicable)
    2. Is your school Title 1?
    3. Who is your Primary Audience?
    4. Please select the descriptor that best matches your work? / What is your educator role? (e.g., nonformal education, teacher)
    5. What stage are you at in your career?
    6. What subject(s) do you primarily teach?
    7. Who will you teach using the information and materials from this workshop? (Multiple select)
    8. Why did you sign up for this workshop? Check all that apply. (Multiple select
    9. Which of the following statements best describes your general understanding of [insert topic area] topics (e.g., oceanography, marine biology)? 
    • I have little to no understanding of [topic area] topics.
    • I have a basic understanding of [topic area] topics but lack depth.
    • I have a moderate understanding of [topic area] topics and can discuss them with some confidence.
    • I have a good understanding of [topic area] topics and can explain them well.
    • I have an advanced understanding of [topic area] topics and can teach them comprehensively.
    10. Are there any specific questions you hope to have answered about [topic] or materials you are looking for to support teaching about [topic] in your educational setting? (Free response)
    11. Have you previously participated in a [insert type of workshop] workshop offered by NOAA?


    12. Please indicate how much you agree or disagree with each of the following statements. (5-point Likert scale, strongly disagree to strongly agree)
    • I feel confident in being able to incorporate [topic] content into the classroom.
    • I have a foundational understanding of [topic].
    • I understand how [topic] fits into/support current science standards and curriculum.
    • I am aware of classroom-ready, teacher-tested resources about [topic].
    • I am aware of other [topic] resources from NOAA.
    13. How familiar are you with the [science topic]? 
    • Not at all familiar
    • Slightly familiar
    • Somewhat familiar
    • Very familiar
    • Extremely familiar
    14. How did you hear about this learning opportunity?  (Multiple choice)
For Grant webinar registrations:
    1. Please select which region(s) your potential application for funding will work in (multiple choice):
    2. Please list any questions regarding the application process or general application content.

Public Burden Statement
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0690-0038. Without this approval, we could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to Adrienne Thomas at [email protected] 
Privacy Act Statement 

Authority: The collection of this information is authorized under 5 U.S.C. § 301 (Departmental regulations), 5 U.S.C. § 552a (Records maintained on individuals), 15 U.S.C. § 1512 (Powers and duties of Department), 44 U.S.C. § 2904 (General responsibilities for records management). 
Purpose: An individual’s permission is required for the collection of names, location, email contact information, and organization affiliation. The collection of this information is encouraged for the webinar registration to best tailor the information to attendees and provide information to registrants. 
Routine Uses: NOAA will use this information for the purpose set forth above and the information may be used consistent with all of the published routine uses as identified in the Privacy Act System of Records Notice COMMERCE/DEPT-23, Information Collected Electronically in Connection with Department of Commerce Activities, Events, and Programs. Disclosure of this information is permitted under the Privacy Act of 1974 (5 U.S.C. Section 552a) to be shared among Department staff for work-related purposes. 
Disclosure: Furnishing this information is voluntary; however, if the information is not provided or if the individual does not consent to the routine uses of the information described in this Statement, the individual would not receive webinar reminders or follow up information. Proceeding with the process constitutes consent for NOAA to collect the information and conduct the routine uses of the information described in this Statement.