Skype A Scientist - Spring 2018- Scientist Form (Matching happens every 2 weeks)
I need the following information in order to match you with a classroom
Email address *
Please confirm your e-mail address *
Your answer
What is your name? *
Your answer
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). *
Your answer
To be extra-sure your teacher can reach you, you may provide a phone number here
Your answer
What University/Institute/Company/Hospital are you associated with? *
Your answer
What time zone are you located in? *
What kind of scientist are you (click all that apply to you) *
Required
What specifically do you study (in 5 words or fewer)? *
Your answer
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)
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?
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?) *
We are experimenting with a reminder e-mail system. Would you like to opt in to reminders after you get a match? *
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 skypeascientist@gmail.com *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service