K-12 Outreach Request

School Name(Required)

School Address(Required)

Street

City

State

Zip

Name(Required)

First

Last

Phone(Required)

Email(Required)

School phone

What is the event type?

Is this a GenCyber program?

Yes
No

If you are requesting an Enrichment Talk, please refer to our catalog and indicate your choices below.

NSA K-12 Outreach Catalog

K-12 Talk Menu Options

If you selected STEM/Language Judging:

How many judges are needed:

Estimated number of student projects:

Specific expertise required?

Is the event Virtual or In-person?

Virtual
In-Person

Grade Level(s)(Required)

Event date and time

Or desired date range

If your event takes place outside of our local area, our engagement with your students will be virtual, even if your students are meeting in-person. Please fill-out this section if your event is Virtual; otherwise, skip to the In-Person section

Number of Virtual sessions

Average number of students per Virtual session

What is the platform (e.g. Google Meet, Zoom, MS Teams)?

Does the platform allow guest or co-host access?

Yes
No

If your event takes place in an area where there is a local NSA presence, complete the information below. Otherwise, please complete the Virtual Event section above.

Number of classes/groups

Average number of students per class/group

What is the event format?

Classroom
Panel
Information Table
Other

Please specify details in additional information section below

List any special requirements for visitors

Additional event information (Virtual and In-Person):

Include information to help with event planning (e.g specific career day focus, number of panel members requested, at/below grade level).

Specify other

K-12 Outreach Request

School Information:

Requester Information:

Event

Virtual Speaker Information:

In-person Speaker Information:

Additional event information (Virtual and In-Person):

How did you hear about us?

NSA.GOV

CULTURE

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RESOURCES

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