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
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First Name
Last Name
Gender
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Please Select
Female
Male
Business Affiliation
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Business Phone Number
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Area Code
Phone Number
Personal Phone Number
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-
Area Code
Phone Number
E-mail
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Alternate E-mail
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Availability
What is the best way & time to contact you?
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Availability
Mornings
Afternoons
Evenings
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Your closest metropolitan area
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Please Select
Downtown Sacramento
Greenhaven/Pocket
Land Park/Curtis Park
Arden-Arcade
Natomas
Elk Grove
Roseville
Other
Qualifications
I understand that I am committing to one hour per week for volunteer mentoring
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Yes
No
I am willing to undergo a background screening and fingerprinting as a volunteer mentor.
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Yes
No
Current or most recent Employer
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Current or most recent job title
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Field of Academic Degree
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Degree obtained from, and year:
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Please check off all categories that you are comfortable discussing with your mentees:
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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
Other
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.
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Resume Upload: Please upload your professional resume, your resume will be kept on file as part of your profile.
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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?
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Yes
No
Do you have any prior arrests or convictions on record?
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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.)
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Yes
No
Do you participate in any other area mentoring programs or volunteer time within a classroom?
Yes
No
If so, what programs?
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