Skype a Scientist- Educator form- SPRING 2018 (matching occurs every 2 weeks)
****Please fill out one form for EVERY CLASS  that will be participating****

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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 are you associated with? *
Where is your school located? (City, State abbreviation, e.g. Philadelphia, PA) *
What topics will your students be covering this semester? (be brief, 200 character limit) (NOTE: this is just for our information, we do NOT match based on keywords from this 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, but if you really want a specific type, only put in that type) *
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.
Will your session need to be conducted in a language other than English? If so, please mark here.
Clear selection
If you know a specific scientist you'd like to work with, please write their name here. By putting ANYTHING in this box, you will likely delay being matched.
How did you hear about the program? *
We are experimenting with a reminder e-mail system. Would you like to opt in to reminders after you get a match? *
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