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Amateur Radio in Space - ER - NASA

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Appendix B<strong>Space</strong> <strong>Amateur</strong><strong>Radio</strong> Experiment(SAREX)Application FormThis application is for: [ ] SAREX [ ] MirEX [ ] No PreferenceSchool Information1. School name: _________________________________________________2. Coord<strong>in</strong>at<strong>in</strong>g teacher: __________________________________________3. School address: ____________________________________________________________________________________________________________4. School city: ___________________________________________________5. School state: __________________________________________________6. School ZIP: ___________________________________________________7. School country: _______________________________________________8. School phone number: _________________________________________9. School FAX number:___________________________________________10. Has the school previously been selected? (YES or NO): _____________11. If YES, which mission? STS: ____________________________________<strong>Radio</strong> Contact Coord<strong>in</strong>ator(To be filled out by an <strong>Amateur</strong> <strong>Radio</strong> operator)12. Name: _______________________________________________________13. Call sign:_____________________________________________________14. Address: _____________________________________________________15. City: ________________________________________________________16. State: ________________________________________________________17. ZIP: _________________________________________________________18. Country: _____________________________________________________19. Work phone number: __________________________________________20. Home phone number: __________________________________________21. FAX number: _________________________________________________<strong>Amateur</strong> <strong>Radio</strong> <strong>in</strong> <strong>Space</strong>—A Teacher’s Guide With Activities <strong>in</strong> Science, Mathematics, and Technology 30

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