Melanoma Education Foundation
Free melanoma lessons for middle and high school students

Registration
for free access to educational videos

We are committed to offering free melanoma lessons, but we need for teachers to complete a one-time registration form. We do not sell or give away the information we collect, but knowing how many teachers are using our lessons in their classroom helps us obtain funding.

We appreciate your taking the time to fill out the form.

* Work Email Address
 Must be a vaild email address - you will use this to log in.
* Password
* Confirm Password
 Must be at least 6 characters long and contain one digit and one letter or symbol.

* Create a Security Question
* Security Response
 You'll be asked to provide this response if you forget your password.



* Choose the single response that best describes your role
* School, District, or Organization
 Please use full names for schools, e.g. "Central Middle School" instead of "Central MS" or "Central".

* First Name
* Last Name

* Position
* Position Other Type
* City/Town
* State/Province
Country (if not US)
* Main school or administrative office phone



* Have you watched the MEF melanoma teacher-education video previously or attended an MEF teacher workshop?
Have you or any teacher(s) you supervise presented the MEF melanoma lesson previously?

* Most recent school year in which lesson was presented:

* Subject name(s) in which student lesson was presented(check all that apply)
* Other Subject

* Grade(s) in which student lesson was presented

List the names of schools where you or teachers you directly supervised presented the lesson during the 2016-17 school year. If none leave the space blank.
 Please use full names for schools, e.g. "Central Middle School" instead of "Central MS" or "Central".

Roughly how many students received the lesson in the most recent school year when it was presented?

Items Presented(check all that apply)


* Do new health lessons require your approval?

* Do you anticipate using the lesson in more than one school in the current school year?

* Subject name(s) in which student lesson would most likely be presented during the 2017-18 school year?(check all that apply)
* Other Subject

* Grade(s) in which student lesson will most likely be presented:

* Is grade 9 considered to be:

* Will student lesson most likely be presented during:

* Are health/wellness classrooms equipped with internet access and either a digital projector or SmartBoard?


Comments/Questions