Choose one of the following: *
I am starting a new Unified Robotics™ team for the 2016 season.I am interested in learning more about Unified Robotics™.

STEP 1 – School Information

School Name *

School District *

Address *




School Principal Information

Principal Name *

Principal Email *

Special Education Adult Representative Information

Representative Name

Representative Email

STEP 2 – Team Information

Are you a part of a competitive robotics program?

Team Name

Team Number

Affiliated Program

FIRST® District

Team Email

Robotics Student Representative Information

Student Representative Name

Student Representative Email

Head Coach Information

Coach Name

Coach Email

Unified Robotics Adult Representative Information

Adult Representative Name *

Adult Representative Email *

STEP 3 – Members and Resources

How many LEGO® MINDSTORMS® NXT kits does your school/team have? *

How many LEGO® MINDSTORMS® EV3 kits does your school/team have? *

How many PCs does your school/team have? *

How many athletes (i.e. students with an intellectual disability) are on your team? *

How many partners (i.e. students without an intellectual disability) are on your team? *

STEP 4 – Carbon Copy and Agreement

What email address would you like a copy of this form to be sent to? *

This form is accurate and true. *
I agree.

My team and I are committed to participating in Unified Robotics™. *
I agree.I am only interested.