Mentor Sign Up

Mentor Sign Up

The NorCal STEM Education Foundation thanks you for agreeing to serve as a volunteer mentor for 5th-11th grade students in the greater Northern California region. In order to properly match your skills to student needs, please complete this form as thoroughly as possible! Your personal information will not be shared beyond the purposes of this registration and program.
Contact Information
Full Name *

First Name Last Name
Gender *
Business Affiliation *
Business Phone Number

Area Code Phone Number
Personal Phone Number *

Area Code Phone Number
E-mail *
Alternate E-mail
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Availability
What is the best way & time to contact you? *

Availability

	Mornings	Afternoons	Evenings
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Your closest metropolitan area *
Qualifications
I understand that I am committing to one hour per week for volunteer mentoring *

Yes No
I am willing to undergo a background screening and fingerprinting as a volunteer mentor. *

Yes No
Current or most recent Employer *
Current or most recent job title *
Field of Academic Degree *
Degree obtained from, and year: *
Please check off all categories that you are comfortable discussing with your mentees: *

Animal Sciences Behavioral and Social Sciences Biochemistry Cellular & Molecular Biology Chemistry Computer Science Earth & Planetary Science Engineering: Electrical & Mechanical Engineering: Materials & Bioengineering Energy & Transportation Environmental Management Environmental Science Mathematical Sciences Medicine & Health Science Microbiology Physics & Astronomy Plant Sciences
List any laboratory equipment or lab time that you can provide to assist the student researchers in their experimentation.
Please use this space for additional comments about your professional background. This information will assist us when making a placement decision.
Upload a photo: Please upload a photo for your profile.
Resume Upload: Please upload your professional resume, your resume will be kept on file as part of your profile.

Upload a File

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Mentorship Policies

Policies have been established to provide the best possible mentoring experience for students, mentors, parents, sponsors and others involved. Note: You may be subject to a background check as well as fingerprinting in order to comply with campus requirements.
Are you currently enrolled in any Child Protection Program? *

Yes No
Do you have any prior arrests or convictions on record? *

Yes No
Are you familiar with the Intel International Science and Engineering Fair Rules and Guidelines? (Students must adhere to these rules to participate in Science Fairs. See http://student.societyforscience.org/intel-isef for Rules, Forms and Guidelines.) *

Yes No
Do you participate in any other area mentoring programs or volunteer time within a classroom?

Yes No
If so, what programs?
Should be Empty:

Mentor Sign Up

Contact Information

Availability

Qualifications

Mentorship Policies