Dinner with a Scientist 2018 - Scientist Registration Form
WE STILL NEED 1-2 SCIENTISTS FOR EACH EVENT. IF YOU WOULD LIKE TO PARTICIPATE, PLEASE EMAIL CALEB CHEUNG (CALEB.CHEUNG@OUSD.ORG) FIRST TO SEE IF THERE IS STILL ROOM.

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Dear Local Scientist,

Thank you for your interest in being a featured scientist at one of the 2018 OUSD Dinner with a Scientist events. Use this site to register only if you have previously participated, belong to one of our partner organizations, or have contacted Caleb Cheung in advance.

Guest scientists are the main feature of this event. By registering, you are making a firm commitment to participate.

All scientists are expected to attend the entire event from 5-8 pm. You will be sharing about your work, answering questions, and leading a short activity at your table related to your work. We are happy to help you plan the activity if you need assistance.

The information below will be used in the event program. Please make sure all information is grammatically correct as we need to enter the information for over 50 scientists into our programs.

The registration deadline is April 20. Additional information is on our website at http://science.ousd.org/dinner.htm

Thanks again for supporting our teachers and students!

Caleb Cheung
Director of Education
Chabot Space and Science Center
caleb.cheung@ousd.org

Email address *
FULL Name (First and Last) *
Your answer
We might have a need for scientists to attend more than one event. How many events might you be interested in attending? We will confirm on April 21. *
Please select the dates you can attend. We will finalize the assignments on April 21 and let you know at that time. *
Indicated if you have participated in any Dinner with a Scientist events in the past. *
Required
Work Place or Organization Affiliation *
Your answer
Please provide the name of the partner organization (if different from above) or the name of the person who invited you to participate.
Your answer
Job Title (please use a title that makes the most sense to students, shorten long official titles to <15 characters) *
Your answer
Scientific Field (Biology, Chemistry, Paleontology, Electrical Engineering, Medicine, etc.) *
Your answer
Mark any group(s) that describe your background. Please note that the purpose of this question is to support our recruitment of underrepresented groups in the science profession. (Check all that apply) *
Required
Email Address (Note that all event communication will be through email. Please enter one that will be checked daily and make sure it is accurate.) *
Your answer
Work Phone *
Your answer
Cell Phone (in case of emergencies) *
Your answer
Home Phone (in case of emergencies)
Your answer
I give permission to release the following contact information to the teachers and students in attendance. Check all that apply. *
Required
Let us know if you have any dietary needs.
Your answer
Provide a short biography for the event program in first person. Details can include your education, a brief work history, WHY you went into science, WHAT sparked your interest in science, and anything that would encourage our students to enter the field of science. This will be included with your name in the event program. Please use student friendly language. For sample bios, please view one of our past event programs on our website. If you are a returning scientist and would like us to reuse your bio from previous years, please indicate accordingly below. (75 WORDS MAX) *
Your answer
Please describe the activity you plan on sharing with students at the dinner table. The activity should be ~10 minutes, hand-on, and engaging. Keep in mind that you will be conducting the activity around food and with three different groups through out the evening. Access to electricity is extremely limited. Please let us know if you need help planning an activity.
Your answer
Any comments?
Your answer
Thank you! Please click submit when you are finished. We look forward to having you join us and will contact you a week before the event with more information. If you have any questions, contact Caleb Cheung.
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