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!
Confirm primary e-mail address
What is your name?
Some school district spam filters prevent us from contacting you. Please provide a second e-mail address.
Please type your secondary e-mail address again
Please provide a phone number which your scientists can call to schedule a session (Optional, but strongly suggested)
What school or group are you associated with?
Where are you located? (City, State abbreviation, e.g. Philadelphia, PA)
What time zone are you in?
Pacific Standard Time (GMT-8:00)
US Mountain Time (GMT-7:00)
Central Standard Time (GMT-6:00)
Eastern Standard Time (GMT-5:00)
Greenwich mean time
European Central Time (GMT+1:00)
Eastern European Time (GMT+2:00)
Eastern African Time (GMT+3:00)
Middle East Time (GMT+3:30)
Near East Time (GMT+4:00)
Pakistan Lahore Time (GMT+5:00)
India Standard Time (GMT+5:30)
Bangladesh Standard Time (GMT+6:00)
Vietnam Standard Time (GMT+7:00)
China Taiwan Time (GMT+8:00)
Japan Standard Time (GMT+9:00)
Australian Central Time (GMT+9:30)
Australian Eastern Time (GMT+10:00)
Solomon Standard Time (GMT+11:00)
New Zealand Time (GMT+12:00)
Midway Islands Time (GMT-11:00)
Hawaii Time (GMT-10:00)
Alaska Time (GMT-9:00)
Puerto Rico and US Virgin Islands Time (GMT-4:00)
Canada Newfoundland Time (GMT-3:30)
Argentina Standard Time (GMT-3:00)
Central African Time (GMT-1:00)
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)
Veterinarian (VERY limited)
Medical Doctor (VERY limited)
Materials Scientist (VERY limited)
What age group/grade are you working with?
We're a group of adults
We're a group at a correctional facility
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.
I would like a female scientist
I would like an LGBT scientist
I would like a 1st generation college scientist
Will your session need to be conducted in a language other than English? If so, please mark here.
American Sign Language
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.
If you have a second choice for a specific scientist, please write their name here
How did you hear about the program?
Word of Mouth (someone you knew told you about it)
Skype in the Classroom/ Microsoft Educator Community
Department of Education (including state chapters)
Communication from your district
I received a post card
I saw an internet ad
I participated in a previous semester
For the sake of know what demographics we're reaching, please click any of the following that apply to your group
After school program
None of these
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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