ODU GenCyber Camp Teacher Registration

Old Dominion University's GenCyber summer combination camps will recruit 10 high school teachers -- particularly JROTC instructors -- to have professional development in cybersecurity, including pre- and post-camp training and one-week camp professional learning. Teachers will receive $1,200 summer stipends plus free lab kits and much more! The two summer camps (Camp1: Jul. 10-14; Camp2: 17-21) will be hosted at the School of Cybersecurity computer lab. For further information, please contact gencyber@odu.edu.

You may return to complete this form. You have 30 days from beginning the form to complete it.

Teacher Name Teacher Name * First Last
For Last Name, enter last name or family name.
Teacher Email *
Emergency Contact Name Emergency Contact Name * First Last
For Last Name, enter last name or family name.
Emergency Contact Phone Emergency Contact Phone * - ### - ### ####
Please provide alternative emergency contact/s including: Name, relationship,address, phone and email *
Which Camp would you like to join? Teachers to both camps must attend from 8:30 a.m. to 5 p.m. Monday through Friday with a half-hour lunch. *

Which Camp would you like to join? Teachers to both camps must attend from 8:30 a.m. to 5 p.m. Monday through Friday with a half-hour lunch. Camp 1: July 10-14 Camp 2: July 17-21
Can you attend every day of camp from Monday through Friday? *

Can you attend every day of camp from Monday through Friday? Yes Other Other
Have you taught any courses in computer science and/or cybersecurity? *

Have you taught any courses in computer science and/or cybersecurity? Yes No
Please list the course you taught.
Do you have any experience in cybersecurity? *

Do you have any experience in cybersecurity? Yes No
Please describe your experience.
What are your objectives in teaching camp? *
What is your school's name? *
What is your school's address? What is your school's address? *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
What is your school's phone number? What is your school's phone number? * - ### - ### ####
Which Junior ROTC program do you join as an instructor? (If applicable.) *

Which Junior ROTC program do you join as an instructor? (If applicable.) Naval JROTC Air Force JROTC Army JROTC Marine Corps Not in any JROTC program Other Other
Which grades do you usually teach? (Check all that apply.) *

Which grades do you usually teach? (Check all that apply.) 9 10 11 12 Other Other
How many years have you been teaching? *
Ethnicity (Check all that apply) *

Ethnicity (Check all that apply) African American American Indian/Alaska Native Asian Hispanic/Latino Native Hawaiian/Other Pacific Islander White/Caucasian Other Other
Multiple Choice *

Multiple Choice Male Female Other (Please list preferred pronouns) Other (Please list preferred pronouns)
T-Shirt Size (Adult) *

T-Shirt Size (Adult) XS S M L XL XXL
How did you hear about Gen/Cyber Camps (Check all that apply.) *

How did you hear about Gen/Cyber Camps (Check all that apply.) Email from Old Dominion University Old Dominion University website Friend or teachers at school Social media Internet search Other Other
Done revising your application and ready to submit your form for review? Check the box below.

Note: You have up to 30 days to adjust your form until the deadline date of July 1. All submissions will be reviewed at that time.

Done revising your application and ready to submit your form for review? Check the box below.

Note: You have up to 30 days to adjust your form until the deadline date of July 1. All submissions will be reviewed at that time. Yes, I am ready to submit my form