EDUCATOR REGISTRATION FORM Please complete the following form to help us match you with a business that aligns with your interests. Contact Careerockit Team if you have questions. CONTACT INFORMATION Educator Name*Email* Office Phone Number*Cell Phone NumberMy organization/school participated in a previous Careerockit.*YESNOI personally have participated in a previous Careerockit.*YESNOSCHOOL INFORMATION School* School NameAbraham Lincoln High SchoolAccelereAckerman Elementary SchoolAdams Elem SchoolA-H-S-T Elementary SchoolAhstw Secondary SchoolAldrich ElementaryAlegent/Immanuel RtcAlfonza W Davis Middle SchoolAlice Buffett Magnet Elem SchAlice Buffett Magnet MsAll Saints Catholic SchoolAlternatives Academy/JourneysAnderson Grove Elementary SchArchbishop Bergan Catholic SchoolArlington Elementary SchoolArlington High SchoolAshland Park/Robbins Elem SchAshland-Greenwood Elem SchoolAshland-Greenwood High SchoolAshland-Greenwood Middle SchAvery Elementary SchoolBancroft ElementaryBeadle Middle SchoolBeals Elem SchoolBell ElementaryBell Field Elementary SchoolBelle Ryan Elem SchoolBelleaire Elementary SchoolBellevue East Sr High SchoolBellevue Elementary SchoolBellevue Mission Middle SchoolBellevue West Sr High SchoolBelvedere Elementary SchoolBennington Elementary SchoolBennington Secondary SchoolBenson Magnet High SchoolBenson West Elem SchoolBertha Barber Elementary SchBetz Elementary SchoolBeveridge Magnet Middle SchoolBirchcrest Elementary SchoolBishop Neumann High SchoolBlack Elk Elementary SchoolBlackburn Alternative ProgramBlair Arbor Park Intermediate SchoolBlair Christian AcademyBlair High SchoolBlair North Elementary SchoolBlair South Elementary SchoolBloomer Elementary SchoolBlumfield Elementary SchoolBoyd Elem SchoolBoys Town High SchoolBoys Town Intervention/Assessment Interim ProgramBridgewood EducationBrook Valley SchoolBrownell Talbot SchoolsBryan Elementary SchoolBryan High SchoolBryan Middle SchoolBurke High SchoolCareer CenterCarl A Swanson Elementary SchCarriage Hill Elementary SchCarter Lake Elementary SchoolCastelar Elementary SchoolCatlin Magnet CenterCedar Bluffs Elementary SchoolCedar Bluffs High SchoolCedar Bluffs Middle SchoolCedar Bluffs PreschoolCentral Elementary SchoolCentral High SchoolCentral Park Elem SchoolChandler View Elem SchoolChap CenterChrist The King SchoolClarmar Elementary SchoolCody Elementary SchoolCollege View ElementaryColumbian Elem SchoolConcordia AcademyConcordia Jr/Sr High SchoolConestoga Alternative ProgramConestoga Elementary SchoolConestoga Jr/Sr High SchoolConestoga Magnet Elem SchoolCornerstone Christian SchoolCottonwood Elementary SchoolCreighton Preparatory SchoolCrescent Elementary SchoolCrestridge Magnet CenterDaniel J Gross Catholic High SchoolDavenport SchoolDeerfield Elementary SchoolDodge Elem SchoolDouglas Co West Elementary SchDouglas Co West High SchoolDouglas Co West Middle SchoolDouglas County Youth CenterDruid Hill Elementary SchoolDuchesne Academy Of The Sacred HeartDundee Elem SchoolE A Kreft Primary SchoolEagle Elementary SchoolEarly Childhood Center At Educare - Indian HillEarly Childhood Center At Educare - KellomEarly Childhood Center At GatewayEarly Childhood Center At YatesEdison Elem SchoolEdison Elementary SchoolElementary Sch At ValparaisoElementary School At CerescoElementary School At HermanElementary School At ScribnerElkhorn Early Education CenterElkhorn Grandview Middle SchoolElkhorn High SchoolElkhorn Middle SchoolElkhorn Ridge Middle SchoolElkhorn South High SchoolElmwood-Murdock Elem SchoolElmwood-Murdock Jr/Sr High SchEsl Teen Literacy ProgramEsu 2 Independent SchoolEzra Millard Elementary SchFairview Elementary SchoolField Club Elem SchoolFire Ridge Elementary SchoolFirst Baptist SchoolFlorence Elem SchoolFontenelle Elem SchoolFort Calhoun Elementary SchoolFort Calhoun High SchoolFort Crook Elementary SchoolFranklin Elem SchoolFranklin Elementary SchoolFremont Learning CenterFremont Middle SchoolFremont Senior High SchoolFriedel Jewish AcademyFullerton Magnet CenterG Stanley Hall Elementary SchGateway ElementaryGateway To CollegeGerald Otte Blair Middle SchGerald W Kirn Middle SchoolGethsemane Elementary SchoolGilder Elem SchoolGolden Hills Elementary SchoolGomez Heritage Elementary SchGood Shepherd Lutheran SchoolGrace Abbott Elem SchoolGrant Elementary SchoolGretna Elementary SchoolGretna High SchoolGretna Middle SchoolHarrison Elem SchoolHarry Andersen Middle SchoolHartman Elem SchoolHarvey Oaks Elementary SchoolHeartland Christian SchoolHeartland SchoolHeritage ElementaryHickory Hill Elementary SchHighland Elem SchoolHillrise Elementary SchoolHillside Elementary SchoolHitchcock Elementary SchoolHolling Heights Elem SchoolHoly Cross SchoolHoly Name SchoolHoover Elementary SchoolHorizon High SchoolHoward Elementary SchoolHowells-Dodge Elementary School/DodgeImmanuel Lutheran SchoolIndependent Study ProgramIndian Hill Elem SchoolIntegrated Learning ProgramIntermediate School At ValparaisoJ P Lord ProgramJ Sterling Morton Elem SchoolJackson Elementary SchoolJefferson Elem SchoolJesuit AcademyJohnson Crossing Academic Center (5-6)Joslyn Elem SchoolKaren Western Elementary SchKellom Elementary SchoolKennedy Elem SchoolKiewit Middle SchoolKing Elementary SchoolKing Science/Tech Magnet ElemKing Science/Tech Magnet M SLa Vista Junior High SchoolLa Vista West Elementary SchLegacy Primary SchoolLemay Elementary SchoolLeonard Lawrence Elem SchoolLewis & Clark Elementary SchoolLewis & Clark Middle SchoolLewis Central Middle SchoolLewis Central Senior High SchoolLiberty Christian SchoolLiberty Elementary SchoolLifegate Christian SchoolLinden Elementary SchoolLogan Fontenelle Middle SchoolLogan View ElementaryLogan View Jr/Sr High SchoolLongfellow Elementary SchoolLothrop Magnet CenterLouisville Elementary SchoolLouisville High SchoolLouisville Middle SchoolLoveland Elementary SchoolMadonna SchoolManchester Elementary SchoolMarian High SchoolMary Our Queen SchoolMasters Elem SchoolMc Millan Magnet Middle SchoolMead Elementary SchoolMead High SchoolMeadows Elementary SchoolMercy High SchoolMillard Central Middle SchoolMillard North High SchoolMillard North Middle SchoolMillard South High SchoolMillard West High SchoolMiller Park Elem SchoolMilliken Park Elementary SchMinne Lusa Elem SchoolMockingbird Elementary SchoolMonroe Middle SchoolMontclair Elementary SchoolMontessori Childrens AcademyMontessori Childrens HouseMontessori Children'S RoomMontessori Educational Center-Childrens HouseMontessori Educational Center-Childs WorldMontessori Educational Center-House Of MontessoriMontessori Educational Ctr-Emma Kopecky El Day SchMontessori Educational Ctr-West Maple MontessoriMontessori International School Of The PlainsMontessori Learning Center Of DundeeMontessori Parents CoopMorton Magnet Elementary SchMorton Magnet Middle SchoolMount Michael Benedictine High SchoolMount View Elem SchoolMt Calvary Lutheran SchoolNathan Hale Magnet Middle SchoolNe Correctional Youth FacilityNeihardt Elementary SchoolNorman Rockwell Elem SchoolNorris Elementary SchoolNorris Middle SchoolNorth Bend Central Elementary SchoolNorth Bend Central High SchoolNorth Bend Central Middle SchoolNova Alternative SchoolOak Valley Elem SchoolOakdale Elementary SchoolOmaha Christian AcademyOmaha Home For Boys SchoolsOmaha Memorial Sda SchoolOmaha North Magnet High SchoolOmaha Northwest Magnet High SchoolOmaha Public Schools HomebasedOmaha South Magnet High SchoolOmaha Street SchoolOur Lady Of Lourdes SchoolPaddock Road Elementary SchoolPalisade'S Elementary SchoolPapillion Junior High SchoolPapillion-La Vista Early Childhood Center (Plecc)Papillion-La Vista Senior HighPapillion-La Vista South HsParkview Heights Elem SchoolParrish ProgramPatrick J Thomas Juvenile CntrPatriot ElementaryPawnee Elem SchoolPeter Sarpy Elementary SchoolPhoenix Academy Day SchoolPicotte Elementary SchoolPine Creek ElementaryPinewood Elem SchoolPlatteview Central Jr High SchoolPlatteview Senior High SchoolPlattsmouth Early ChildhoodPlattsmouth Elementary SchoolPlattsmouth High SchoolPlattsmouth Middle SchoolPonca Elem SchoolPortal Elementary SchoolPrairie Lane Elementary SchoolPrairie Wind Elem SchoolPrimrose School Of LegacyR M Marrs Magnet Elem SchoolR M Marrs Magnet Middle SchoolRalston High SchoolRalston Middle SchoolReagan ElementaryReeder Elementary SchoolRiverside Community High SchoolRiverside Community Intermediate SchoolRockbrook Elementary SchoolRohwer Elementary SchoolRoncalli Catholic High SchoolRoosevelt Elementary SchoolRose Hill Elem SchoolRtc EastRtc SudykaRtc WestRue Elementary SchoolRumsey Station Elementary SchRussell Middle SchoolSacred Heart Elementary SchoolSaddlebrook Elementary SchoolSagewood Elementary SchoolSandoz Elementary SchoolSaratoga Elem SchoolSarpy Co Coop Head Start-BellevueSarpy Co Coop Head Start-GretnaSarpy Co Coop Head Start-Papillion-La VistaSarpy Co Coop Head Start-Springfield PlatteviewScribner-Snyder Secondary SchSecondary Success ProgramSeymour Elementary SchoolSherman Elem SchoolSkinner Magnet CenterSkyline Elementary SchoolSpring Lake Magnet CenterSpring Ridge ElementarySpringfield Elementary SchoolSpringville Elem SchoolSquire John Thomas ElementarySs Peter & Paul Elementary SchoolSt Albert Catholic SchoolsSt Bernadette SchoolSt Cecilia Cathedral SchoolSt Columbkille SchoolSt James Seton SchoolSt Joan Of Arc SchoolSt John Nepomucene SchoolSt John The Baptist SchoolSt Margaret Mary SchoolSt Mary Elementary SchoolSt Matthew SchoolSt Patrick'S Catholic SchoolSt Paul Lutheran SchoolSt Philip Neri SchoolSt Pius X/St Leo Elementary SchoolSt Robert Bellarmine SchoolSt Stephen The Martyr SchoolSt Vincent De Paul SchoolSt Wenceslaus Elementary SchoolSt Wenceslaus SchoolStanding Bear Elementary SchStudent Service CenterSunny Slope Elem SchoolSunset Hills Elementary SchoolSword Of The Spirit Elementary-High SchoolTara Heights Elementary SchoolThomas Jefferson High SchoolTitan Hill Intermediate SchoolTransition Program At Career CenterTransition Program At Embassy Suites Downtown/OldTransition Program At PvaTransition Program At SaratogaTreynor Elementary SchoolTreynor High SchoolTreynor Middle SchoolTri-Center Elementary SchoolTri-Center High SchoolTri-Center Middle SchoolTrinity Lutheran Elementary SchoolTrumble Park Elementary SchoolTwin Ridge Elementary SchoolTwo Springs Elementary SchoolUnderwood Elementary SchoolUnderwood High SchoolUnderwood Hills Early Childhood Learning CenterUnderwood Middle SchoolUno/Ops Middle College ProgramUpchurch ElementaryUta Hallee Academy ProgramValley View Middle SchoolWahoo Elementary SchoolWahoo High SchoolWahoo Middle SchoolWahoo Pre-SchoolWake Robin Elementary SchoolWakonda Elem SchoolWalnut Creek ElementaryWalnut Elementary SchoolWalnut Hill Elem SchoolWalt Disney Elementary SchoolWashington Elem SchoolWashington Elementary SchoolWeeping Water Elementary SchoolWeeping Water High SchoolWegner SchoolWest Bay Early Ed CenterWest Bay Elementary SchoolWest Dodge Station Early Ed CenterWest Dodge Station ElementaryWestbrook Elementary SchoolWestern Hills Magnet CenterWestgate Elementary SchoolWestmont Elementary SchoolWestridge Elementary SchoolWestside Career CenterWestside High SchoolWestside Middle SchoolWheeler Elementary SchoolWhitetail Creek ElementaryWildewood Elementary SchoolWilla Cather Elementary SchoolWillowdale Elementary SchoolWilson Focus SchoolWoodrow Wilson Middle SchoolYoung Adult ProgramYouth Links-Heartland FamilyYutan Elementary SchoolYutan High SchoolOther School District County Title 1 School Check here if your school is a Title 1 School School-Wide or Grade-Wide Check here if this is a school-wide or grade-wide experience, and please include additional details in the Additional Notes and Comments section below. Grade of Students*(select all that apply CTRL+Click)3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeApprox. Number of Students*4 or fewer5101520253035404550556065707580859095100125150175200225250275300325350375400425450475500525550575600+DATE & TIME Date & Time Availability*Select all the days and times that your students would be available (times are approximate). Please remember to hold the dates you select. Matching will take place Oct. 1 – Nov. 30. Monday - Date & Time Availability Monday, Feb 10th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Tuesday - Date & Time Availability Tuesday, Feb 11th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Wednesday - Date & Time Availability Wednesday, Feb 12th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Thursday - Date & Time Availability Thursday, Feb 13th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Friday - Date & Time Availability Friday, Feb 14th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Saturday - Date & Time Availability Saturday, Feb 15th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Sunday - Date & Time Availability Sunday, Feb 16th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Monday 2 - Date & Time Availability Monday, Feb 17th 8 am to 11 am 1 pm to 3 pm 3 pm to 5 pm 5 pm or later All Day Date & Time AvailabilitySelect the days and times that your students would be available (times are approximate). Monday, Feb 10th - 8 am to 11 am Monday, Feb 10th - 1 pm to 3 pm Monday, Feb 10th - 3 pm to 5 pm Monday, Feb 10th - 5 pm or later Monday, Feb 10th - All Day Tuesday, Feb 11th - 8 am to 11 am Tuesday, Feb 11th - 1 pm to 3 pm Tuesday, Feb 11th - 3 pm to 5 pm Tuesday, Feb 11th - 5 pm or later Tuesday, Feb 11th - All Day Wednesday, Feb 12th - 8 am to 11 am Wednesday, Feb 12th - 1 pm to 3 pm Wednesday, Feb 12th - 3 pm to 5 pm Wednesday, Feb 12th - 5 pm or later Wednesday, Feb 12th - All Day Thursday, Feb 13th - 8 am to 11 am Thursday, Feb 13th - 1 pm to 3 pm Thursday, Feb 13th - 3 pm to 5 pm Thursday, Feb 13th - 5 pm or later Thursday, Feb 13th - All Day Friday, Feb 14th - 8 am to 11 am Friday, Feb 14th - 1 pm to 3 pm Friday, Feb 14th - 3 pm to 5 pm Friday, Feb 14th - 5 pm or later Friday, Feb 14th - All Day Saturday, Feb 15th - 8 am to 11 am Saturday, Feb 15th - 1 pm to 3 pm Saturday, Feb 15th - 3 pm to 5 pm Saturday, Feb 15th - 5 pm or later Saturday, Feb 15th - All Day Sunday, Feb 16th - 8 am to 11 am Sunday, Feb 16th - 1 pm to 3 pm Sunday, Feb 16th - 3 pm to 5 pm Sunday, Feb 16th - 5 pm or later Sunday, Feb 16th - All Day Monday, Feb 17th - 8 am to 11 am Monday, Feb 17th - 1 pm to 3 pm Monday, Feb 17th - 3 pm to 5 pm Monday, Feb 17th - 5 pm or later Monday, Feb 17th - All Day EXPERIENCE Are You Interested In An Experience*In The ClassroomAt a BusinessEitherDistance Your Students Are Willing to Travel From School*Please select one1 mile5 miles10 miles15 miles20 miles25 miles30 miles35 miles40 miles45 miles50 milesAnyI’m interested in being matched with experiences within the following industries*Please note, we can't guarantee you will be matched in your selected fields, however, we will do our very best to accommodate your request. (select all that apply CTRL+Click)Any IndustryAgriculture, Food and Natural ResourcesArchitecture & ConstructionArts, AV Technology & CommunicationsBusiness Management and AdministrationEducation & TrainingEnergy & EngineeringFinanceGovernment & Public AdministrationHealth SciencesHospitality & TourismHuman ServicesInformation TechnologyLaw, Public Safety, Corrections & SecurityManufacturingMarketingTransportation, Distribution & LogisticsNOTES & COMMENTS All notes and comments will be visible to businesses and are subject to editing. Helpful notes to aid in matching might include specific student needs and accommodations, exploratory experiences vs. lecture or discussion experiences, etc. Let the business know what you are looking for.What do you want your students to learn from this experience?(300 Character Limit)Provide Additional Notes and Comments(300 Character Limit) Carefully review your form submission and agreement information below before submitting. By registering, you are agreeing to participate in your matched experience. Although we can't guarantee a match within your requested industry, our team will do our best to connect your classroom/student group with your preferred interest. Please remember to hold the dates you selected. An email with the host business contact information will be sent between Oct. 1 - Nov. 30 after the match is made. We highly discourage changing your plans or backing out of a match except in an emergency situation. We appreciate your commitment to your students' career preparation and to Careerockit!