Science Symposium Mentors 2015-16
Thank you for your interest in working with the students in our Science Symposium Program.

Please complete the information below which will provide us with information used to pair student projects, (students work as individuals, in pairs or in small groups of 3-4 students), with a mentor (this will take place during the month of November).  Once you have been paired with a project, you will be contacted via email.

Please contact Carmen Lombard, (calombard@madison.k12.wi.us, 663-5474) with any questions.  Thank you again for your generosity to work with our students.  
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First Name *
Last Name *
Affiliation (if applicable)
This could include, but is not limited to:  UW/Madison College/Edgewood Student/Grad. Student/Professor, High School, Your place of business (Thermo Fisher, Epic, Dental Office), Parent, etc.
Street Address *
City *
Zip Code *
Phone Number *
Email *
Please indicate which school(s) you are willing to work with: *
If you are willing to work with any school, please check all the boxes.
Required
In order to help facilitate your placement at a school, please provide your main source of transportation. *
Required
Please indicate which days you are available to work with students. *
 Please check all days you are available. As a reminder, the commitment for this program is approximately 1 hour/week from November-April. Time frames include: Mondays from 1:30-3:30, except on the following dates (11/19, 11/16, 11/23, 1/4, 1/25, 2/1, 4/11); these dates & all others days meet from 2:30-4:30. Badger Rock and Wright are late start schools and timing is one hour later than listed.)
Required
Please select your area of expertise. *
Check all that apply.
Required
Use this space to expand on your area of expertise from above if you'd like.
Based on your expertise, please list 2-3 project ideas that you have that could be potential projects for students in our program. *
We are asking this question in an effort to better match students and mentors.  Additionally, we are hoping to use this information as a way to help support and guide students in providing some ideas as to what kinds of topics/projects they might become involved in.  Students won't be limited to these projects, but for those who are not sure what they might be interested in, these could provide some guidance.
In order to help facilitate our pairing of mentors with student projects, select the criteria that is most important to you when answering the following question:  I would prefer that I am matched with a student project based on... *
Would you be willing to work with more than one project (2-3)? *
All efforts would be made to match you with multiple projects based on the criterion you indicated being of most importance from the question above.
Would you be interested in attending a Mentor Training Session that would explain program details and share advice on mentoring?
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Our program requires that we recruit 100+ mentors each year.  If you know of any additional people, organizations, departments, businesses, etc. whom you think might be interested in mentoring, please share this information with them or provide a contact name and email below.
In order to begin your work with students, a Volunteer Disclosure Form needs to be completed and submitted to the MMSD Human Resources office. The link to this form can be found here: https://partnerships.madison.k12.wi.us/files/partnerships/VolunteerDisclosureStatement12.2012.pdf
If you completed a form in the last year, or had completed one prior and have mentored yearly for us with no gap (taking a year off), you do not need to submit a new form.
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Any additional information you'd like to share...
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