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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
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Preferred pronouns (for example, she/her, he/him, they/them)
Your answer
Address
*
Your answer
Parent/Guardian Name(s)
*
Your answer
Parent/Guardian Phone number
*
Your answer
Parent/Guardian Email
Your answer
Parent/Guardian Address (if different from above)
Your answer
Can you receive text messages?
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Date of birth
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MM
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DD
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YYYY
Grade Level
9
10
11
12
Other:
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Name of School
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Current Science, Technology, Engineering, Arts, or Mathematics teachers
Your answer
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):
Your answer
If you have had any other science-oriented experiences, please provide us with general description and timeframe of experience:
Your answer
What are three words or phrases you would use to describe yourself?
Your answer
Why do you want to participate in the Teen Café Program, and how will this be a unique experience for you?
Your answer
If you were selected to participate, what topic(s) would you like to discuss?
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Anything else you would like us to know?
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