Skype a Scientist- Teacher form- Fall 2017
****Please fill out one form for EVERY CLASS that will be participating****
What is your name?
Your answer
What is your e-mail address (please double check for typos)
Your answer
What school are you associated with?
Your answer
Where is your school located? (If you live in the USA, please use City, State abbreviation, e.g. Philadelphia, PA)
Your answer
What time zone are you in?
Class 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
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 class? (I can't promise you will get your top pick, we are mostly molecular biologists and ecologists. VERY limited in chemists and physicists)
Required
What grade are your students in?
Required
Does your class 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.
If you know a specific scientist you'd like to work with, please write their name here.
Your answer
How did you hear about the program?
Submit
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