Teen Science Café Leadership application
Apply to become a Teen Science Café leader! (Completion of application is not an indication of commitment).
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Name *
Email *
Phone number *
Preferred pronouns (for example, she/her, he/him, they/them)
Address *
Parent/Guardian Name(s) *
Parent/Guardian Phone number *
Parent/Guardian Email
Parent/Guardian Address (if different from above)
Can you receive text messages? *
Date of birth *
Grade Level
Clear selection
Name of School
Current Science, Technology, Engineering, Arts, or Mathematics teachers
List up to ten extracurricular activities that you have participated in and any leadership roles you have held (most relevant and/or important, from freshman year to present):
If you have had any other science-oriented experiences, please provide us with general description and timeframe of experience:
What are three words or phrases you would use to describe yourself?
Why do you want to participate in the Teen Café Program, and how will this be a unique experience for you?  
If you were selected to participate, what topic(s) would you like to discuss?
Anything else you would like us to know?
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This form was created inside of Ohio Valley Museum of Discovery.