NSTI Application Form

PTO/NSTI/001
OMB Control No. 0651-0077
Expiration Date: 05/31/2021

PRA Statement of Burden

The United States Patent and Trademark Office (USPTO) is using this application form to apply to the National Summer Teacher Institute. This application is voluntary, includes 30 questions and should take around 30 minutes to complete. This information collection contains requirements subject to the Paperwork Reduction Act (PRA). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to penalty for failure to comply with, a collection of information subject to the requirements of the PRA, unless that collection of information displays a currently valid OMB control number.

All fields are required in order to complete the NSTI application















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(Check all that apply)

Algebra
Biology
Botany
Calculus
Chemistry
Computer Science
Computer-Aided Design
Creative Thinking
Design Thinking
Engineering
Geometry
Graphic Design
Industrial Design
Intellectual Property
Invention Concepts
Materials Science
Mechanics
Other Math Course
Physics
Rapid Prototyping
Robotics
Technology
Trigonometry
Visualization
Welding/Shop
Woodworking
Other

 

(Check all that apply)

Algebra
Biology
Botany
Calculus
Chemistry
Computer Science
Computer-Aided Design
Creative Thinking
Design Thinking
Engineering
Geometry
Graphic Design
Industrial Design
Intellectual Property
Invention Concepts
Materials Science
Mechanics
Other Math Course
Physics
Rapid Prototyping
Robotics
Technology
Trigonometry
Visualization
Welding/Shop
Woodworking
Other

 

(Check all that apply)

Computer Science Club
Entrepreneurship Club
Invention Competitions
Inventors Club
Making/Design/Do-It-Yourself (DIY)projects
Robotics Programs
Science Fair Projects
Scouting
4-H
Other

 


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Privacy Act Statement

The authority for the collection of this information is 5 U.S.C. § 301, 35 U.S.C. § 2, and E.O. 12862. The information you provide will be used to verify your identity and administer participation in the National Summer Teacher Institute. The information you provide is protected from disclosure to third parties in accordance with the Privacy Act. However, routine uses of this information may include disclosure to the following: Congressional offices; Federal, state, local or foreign agencies; a court, magistrate or administrative tribunal; law enforcement; agents or contractors; the Department of Justice; the National Archives and Records Administration; and agency customers in the course of distributing patent and trademark business information. Disclosure of the information by you is voluntary; however, failure to provide any part of the requested information may result in our inability to enroll you in the program. The applicable Privacy Act System of Records Notice for this information request is Commerce PAT/TM-19, Dissemination Events and Registrations, available at https://www.uspto.gov/uspto-systems-records-notices.