Science Symposium Mentors 2016-17
Thank you for your interest in working with the students in our Science Symposium Program.

Please complete the information below which will provide us with information used to pair student projects, (students work as individuals, in pairs or in small groups of 3-4 students), with a mentor.  

Student applications are open from September 26-October 14th, 2016.  Following October 14th, students and mentors will be paired.  Please note this process can often take several weeks. Once a mentor has been paired with a project, they will be contacted via email with next steps for contacting their mentee(s).

Please contact Carmen Lombard, (calombard@madison.k12.wi.us, 663-5474) with any questions.  Thank you again for your generosity in working with our students.  
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First name *
Last Name *
Affiliation (if applicable)
This could include, but is not limited to:  UW/Madison College/Edgewood Student/Grad. Student/Professor, High School, Your place of business (Thermo Fisher, Epic, Dental Office), Parent, etc.
Street Address *
City *
Zip Code *
Cell Phone Number *
If no cell phone, indicate N/A
Other Phone Number
Email *
In order to help facilitate your placement at a school, please provide your main source of transportation. *
Select all that apply.
Required
Please indicate which school(s) you are willing to work with: *
If you are willing to work with any school, please check all the boxes.  Please note that those starred (*) are further away from the UW-Campus and require more than a 30 minute bus ride one way if you do not have a car.
Required
If there are no placements at one of the schools you indicated, would you be willing to extend your choices, taking into consideration if you're taking a bus, the bus ride would be 45-50 minutes.   *
If there are no placements at one of the schools you indicated, would you be willing to mentor a student project(s) on campus if the students had transportation available to them? *
If there are no placements at one of the schools you indicated, would you be willing to mentor a student project(s) digitally, using Skype, Google Hangouts, etc.? *
Please indicate which days you are available to work with students. *
 Please check all days you are available. As a reminder, the commitment for this program is approximately 1 hour/week from November-April. Time frames include: Mondays from 1:30-3:30, except on the following dates (2016:  11/7, 11/14, 11/21, 12/19; 2017: 1/16, 1/23, 1/30, 2/27, 3/27); these dates & all others days meet from 2:30-4:30. Badger Rock and Wright are late start schools and timing is one hour later than listed.)
Required
Please select your area of expertise. *
Check all that apply.
Required
Use this space to expand on your area of expertise from above if you'd like.
Based on your expertise, please list 2-3 project ideas that you have that could be potential projects for students in our program. *
We are asking this question in an effort to better match students and mentors.  Additionally, we are hoping to use this information as a way to help support and guide students in providing some ideas as to what kinds of topics/projects they might become involved in.  Students won't be limited to these projects, but for those who are not sure what they might be interested in, these could provide some guidance.
In order to help facilitate our pairing of mentors with student projects, select the criteria that is most important to you when answering the following question:  I would prefer that I am matched with a student project based on... *
Would you be willing to work with more than one project (2-3)? *
All efforts would be made to match you with multiple projects based on the criterion you indicated being of most importance from the question above.  In working with multiple projects, the expectation is that you'd meet with all individuals/groups on the same day during the same time frame and not on separate occasions unless you opted for the later option.
There will be  Mentor Training Meetings on the following dates, in the following locations.  This is an opportunity to connect with other mentors and get your questions answered.  Please indicate which meeting you are able to attend. *
Our program requires that we recruit 100+ mentors each year.  If you know of any additional people, organizations, departments, businesses, etc. whom you think might be interested in mentoring, please share this information with them or provide a contact name and email below.
Confidentiality Agreement: I understand that in providing my services as a volunteer with Madison Schools I will respect the confidential nature of the knowledge I will gain concerning the academic performance, behavior and personal information of the children with whom I work. If a child tells me something or I notice something that may indicate his/her safety is at risk or he/she is in emotional distress, I will report that information to my supervising teacher or a support staff member (social worker, psychologist, nurse). I also agree not to initiate contact with the children with whom I work or their families outside of the school or program setting to which I have been assigned. *
Please indicate your agreement with the statement above.  Checking "Yes" and submitting this form electronically shall be deemed the equivalent of a personal signature for the purposes of this acknowledgement.
Best practices:   Do not meet with your mentee alone (one adult, one child), unless you are in a room where there are other people or there is a door or window so you are both visible to others and others are aware of who is meeting where.   It is advisable as a best practice to minimize one-on-one individual meetings with mentees and to meet with at least one additional child or adult when you are able. *
Please indicate your agreement with the statement above.  Checking "Yes" and submitting this form electronically shall be deemed the equivalent of a personal signature for the purposes of this acknowledgement.
In order to begin your work with students, a Volunteer Disclosure Form needs to be completed and submitted to the MMSD Human Resources office. The link to this form can be found here: https://partnerships.madison.k12.wi.us/files/partnerships/VolunteerDisclosureStatement12.2012.pdf
If you completed a form in the last year, or had completed one prior and have mentored yearly for us with no gap (taking a year off), you do not need to submit a new form.
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