The STEM Stars Educator Application

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Educator Questionnaire Form

First Name *

Last Name *

Your Email *

Tell us a little about yourself. 5-10 sentences. *

What is your current educational attainment? *

Which subjects are you proficient in? Please list. *

Do you have aspirations to work in the medical field? *

Yes

Maybe

If you answered Yes to the previous question, please describe your specific aspirations. (If No was answered, please write "N/A") *

Do you have teaching experience? If yes, describe. *

If selected, How much time would you be willing to dedicate to this program per week?

1 hour

2 hours

5 hours

Other:

Clear selection

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