Regional FieldSTEM Coordinator Connection Form

Get connected with your Regional FieldSTEM Coordinator

We'd love to hear from you!

If you are interested in getting connected with your local FieldSTEM coordinator please fill out this form and your coordinator will reach out to you.

Personal Details

First Name

Last Name

Pronouns

How would you like to be reached?

Please use my:

Work EmailPersonal EmailCell phoneWork phone

Work Email

Personal Email

Preferred Phone

Any additional contact details

Educator Details

Please select the category that best describes your profession:

K-12 Classroom Teacher	Non-Formal Educator
CTE Teacher	Pre-K or Day Care Provider
Classified Staff/Paraprofessional	Conservation District Staff
School District Office Staff	City/County Organization Staff
District/School Administrator	Statewide Agency or Organization Staff
Educational Service District Staff	Post-Secondary Educator
Pre-Service Student	Pre-Service Faculty
Tribal Nation Staff	Other

Other Profession

Employer

Please select the grade(s) you teach.

Pre-K	Kindergarten	1st	2nd
3rd	4th	5th	6th
7th	8th	9th	10th
11th	12th	Not Applicable

Your region is determined by your school or organization location. If you work for a school, please also provide the District and School name:

Mailing City

Mailing Zip

District name (if applicable)

School name (if applicable)

Organization Name (Not a school or District)

How can we help?

Please share any comments/questions/or workshop interests you may have.

Extra details

Would you like to be added to PEI's email list?

YesNo

Would you like to provide an email different than the one above?

Are you a bilingual Spanish speaking educator.

YesNo

Contact Information