Skype a Scientist- Group leader form- Fall 2019
****Please fill out one form for EVERY SESSION that will occur****
Have 3 classes? Fill out 3 forms!
Email address *
Confirm primary e-mail address *
Your answer
What is your name? *
Your answer
Some school district spam filters prevent us from contacting you. Please provide a second e-mail address. *
Your answer
Please type your secondary e-mail address again *
Your answer
Please provide a phone number which your scientists can call to schedule a session (Optional, but strongly suggested)
Your answer
What school or group are you associated with? *
Your answer
Where are you located? (City, State abbreviation, e.g. Philadelphia, PA) *
Your answer
What time zone are you in? *
Group meeting time
Only fill out each time slot that your class is available on each day of the week. LEAVE BLANK if your class cannot meet on a certain day of the week

IF you have a variable schedule, that's totally ok, just put a sample week in here.

Monday start time (to the nearest hour, Military format)
Tuesday start time (to the nearest hour, Military format)
Wednesday start time (to the nearest hour, Military format)
Thursday start time (to the nearest hour, Military format)
Friday start time (to the nearest hour, Military format)
What types of scientist would be most appropriate for your group? (I can't promise you will get your top pick, but if you really want a specific type, choose ONLY that type) *
What age group/grade are you working with? *
Does your group have more than 50% of an under-represented minority in science? We will try to match minority scientists with minority-dominated classrooms to give students role models that "look like them" or come from a similar income group.
Will your session need to be conducted in a language other than English? If so, please mark here.
If you know a specific scientist you'd like to work with, please write their name here. Write their name EXACTLY as written on the website, or this will not work. This is NOT a guarantee that you will be matched with the scientist you request. By putting ANYTHING in this box, you will likely delay being matched.
Your answer
If you have a second choice for a specific scientist, please write their name here
Your answer
How did you hear about the program? *
For the sake of know what demographics we're reaching, please click any of the following that apply to your group *
Would you like to opt in to reminders after you get a match? *
This year we are adding LIVE sessions, in which any classroom can watch a session open to everyone and participate. Would you like to opt in to reminders about Skype A Scientist LIVE sessions? *
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