Teacher Liaison Profile Update Teacher Liaison Profile Update Form Teacher Liaison Name on file First Last This field is for confirmation only, if you wish to update this field please email SpaceFoundation.Email Address on file This field is for confirmation only, if you wish to update this field please email SpaceFoundation. Flight-NumberUpdate Your Profile Information If all information is correct, there is no need to submit the changes. Otherwise, please update the information as needed and submit your changes.Personal InformationHome Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneMobile PhoneFacebook linkTwitter LInkLinkedIn LinkWhich of the following most accurately describe you?(Required) Female Male Non-binary Transgender Intersex I prefer not to answer Please indicate your race-ethnicity(Required) American Indian or Alaska Native Asian or Asian American Black or African American Hispanic,Latino,Latina or Latinx Middle Eastern or Northern African Native Hawaiian or Other Pacific Islander White or Caucasian I prefer not to answer Are you a first-generation college graduate?(Required) Yes No I prefer not to answer Pursuant to the Americans with Disabilities Act, do you require specific aids or services?(Required) Yes No I prefer not to answer Are you an active member and/or veteran of the U.S. military?(Required) Yes No I prefer not to answer What branch of the U.S. military are you affiliated with? Air Force and Air Force Reserve Air National Guard Army and Army Reserve Army National Guard Coast Guard and Coast Guard Reserve Marine Corps and Marine Corps Reserve Navy and Navy Reserve Space Force I Have Not Made My Choice School/Organization InformationSchool/Organization Name(Required)Job Title(Required)School/Organization Address(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country School/Organization Email Address School/Organization Facebook LinkSchool/Organization Twitter LinkSchool/Organization Linkedin LinkHow many years have you been teaching?(Required)How many students do you teach in a year?(Required) 30 or below between 31-60 between 61-90 between 91-180 181+ How many students do you teach in a year? 181+ SelectedWhat grades do you teach?(Required) PreK - 2nd 3rd - 5th 6th - 8th 9th - 12th College Informal Education What subjects do you teach?(Required) Elementary School (all subjects) English Language Arts History Social Studies Science Technology Engineering Mathematics Approximately what percentage of your student population are first generation graduates?(Required) 0 to 25% 26% - 50% 51% - 75% 76% - 100% I prefer not to answer Approximately what percentage of your student population would be considered minorities?(Required) 0 to 25% 26% - 50% 51% - 75% 76% - 100% I prefer not to answer Approximately what percentage of your students live at or below the poverty line?(Required) 0 to 25% 26% - 50% 51% - 75% 76% - 100% I prefer not to answer Approximately what percentage of your students have a family member in the military?(Required) 0 to 25% 26% - 50% 51% - 75% 76% - 100% I prefer not to answer Is your school located in a rural community?(Required) Yes No I prefer not to answer Does your school/organization serve students from indigenous populations?(Required) Yes No I prefer not to answer Program ImpactHave you received any grants this year?(Required) Yes No What organization awarded the grant?Please provide links to the grant website, press release, and any other public announcements as applicable.Describe the grant and its impact on you, your students, your school/organization, your community, and beyond.Have you received any awards this year?(Required) Yes No What organization gave the award?Please provide links to the award website, press release, and any other public announcements as applicable.Describe the award and its impact on you, your students, your school/organization, your community, and beyond.Did you deliver any workshops for teachers this year?(Required) Yes No Please provide links to the workshop website, press release, and any other public announcements as applicable.Describe the workshop and its impact on you, your students, your school/organization, your community, and beyond.Did you host any STEM nights this year?(Required) Yes No Please provide links to the STEM night website, press release, and any other public announcements as applicable.Describe the STEM night and its impact on you, your students, your school/organization, your community, and beyondDid you and your students participate in any competitions this year?(Required) Yes No Please provide links to the competition website, press release, and any other public announcements as applicable.Describe the competition and its impact on you, your students, your school/organization, your community, and beyond.Did you work with any other partner organizations this year?(Required) Yes No Please list the organization names.
