Skype A Scientist - Fall 2017- Scientist Form
Need the following information from you guys to match you with a classroom
What is your name?
Your answer
What is your e-mail address? (please double check for typos)
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?
Is there a time of week you are NOT available? If so, when?
Please check languages you would be comfortable doing a SkypeAScientist 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?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms