Student Registration

Please enter the information requested below

Introduction

The first step in entering the A.H. Nickless Innovation Award competition is to create a Student Profile. Once you complete this step and parental approval is received, you can join a team.

Before entering any information, please download and read the Official Rules and Regulations of the Award.

NOTE: Bold fields are required.

Personal Information

Please enter the information requested in each space. Privacy: Please read our privacy statement regarding the personal information entered on this form.

First Name:

Last Name:

Home Address:

City: State: MI Zip Code:

Home Phone: Cellphone:

Email Address:

Birthdate (MM/DD/YYYY): Gender: Male Female

Grade in School

Select your High School from the list below:

(If homeschooled, select the school with which you will be associated.)

Parent or Guardian Information

Parental Consent

Students must request and obtain parental consent before being considered eligible to make any submission for judging.

Parent's or Guardian's First Name:

Parent's or Guardian's Last Name:

Parent's or Guardian's Email Address:

LogIn Information

You will be using your email address and password to access your profile information. Please write down the information you enter for future reference.

Password: (A combination of six to 10 letters and/or numbers ONLY. Include at least one uppercase letter and one number. NO special characters. example: !#$%*@, etc.)

Agreement I have read and agree to follow the Official Rules and Regulations of the Award.

Team Leader

By checking this box, you agree to accept responsibility for creating your team by completing the team registration. You will receive additional instructions via email.

I have agreed to be the leader of a team.

Verification

Verification Information

Type the characters you see in the picture. This ensures that a person, not an automated program, created this profile.

Picture:

Characters: