Fall 2018 Scientist Form
I need the following information in order to match you with a classroom
Please confirm your e-mail address
What is your name?
Some University Spam filters have prevented our e-mails from reaching you. Please provide a secondary e-mail address we can use to send matches (double check for typos).
To be extra-sure your teacher can reach you, you may provide a phone number here
What University/Institute/Company/Hospital are you associated with?
What time zone are you located in?
Eastern Standard Time (GMT-5:00)
Central Standard Time (GMT-6:00)
Pacific Standard Time (GMT-8:00)
US Mountain Time (GMT-7:00)
Hawaii Time (GMT-10:00)
Alaska Time (GMT-9:00)
Greenwich mean time
Australian Eastern Time (GMT+10:00)
Australian Central Time (GMT+9:30)
Japan Standard Time (GMT+9:00)
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)
Solomon Standard Time (GMT+11:00)
New Zealand Time (GMT+12:00)
Midway Islands Time (GMT-11:00)
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)
What kind of scientist are you (click all that apply to you)
What specifically do you study (in 5 words or fewer)?
How many classrooms would you like to be matched with? If after 5 matches you would like more, simply sign up again.
Is there a time of week you are NOT available? If so, when?
Please check languages you would be comfortable doing a Skype a Scientist session in (native or bilingual proficiency)
American Sign Language
Some of the classrooms we're working with will have a high percentage of under-represented minority students. Ideally we want them to meet a scientist that looks like them or can relate to the challenges they may face. This question is completely optional: Are you a member of any of the following?
Low income household (when growing up)
1st generation college student
Are there any grades of students you are NOT willing to skype with?
Are you willing to video chat with groups of adults (e.g. at libraries/clubs/etc?)
Are you willing to video chat with adults in correctional facilities?
Would you like to opt in to reminders after you get a match?
We are highlighting scientists on our website. If you would like to be highlighted (which we hypothesize will increase likelihood of being matched), please upload a photo here.
If you uploaded a photo, please provide a blurb about what you work on that we can include in an instagram post.
How did you hear about Skype a Scientist?
Word of mouth (someone told you about it)
If you are part of an academic society that is participating as a group, please type the name of your group here
By clicking this button, I am confirming that I aware that I can use any video chat platform, not just skype.
Yes, I know I don't have to use skype
By clicking this button I solemnly swear that I will either contact my matched teacher or communicate that my teacher needs to be rematched by e-mailing
Skype a Scientist communication is done via e-mail. Please click this box to confirm that you are willing to receive e-mails from Skype a Scientist.
I confirm that I am willing to receive e-mails from Skype A Scientist
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service