Visiting Scientist Application

Name*

First NameMiddle NameLast Name

Email Address*

example@example.com

Phone Number*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Why are you interested in girls in STEM?*

Field of Study—Briefly describe your field of study/STEM expertise in 1-2 sentences.*

STEM Program Idea—Describe a 20-minute hands-on STEM program for families (~25 people ranging from ages 5–75) that you would facilitate. Describe the content you will cover, materials needed, and how you will engage children and families.*

Please describe any outreach work you have done involving girls in STEM*

File Upload—Please upload, as one PDF document, a CV, brief description of the scientist’s area of study and/or research, examples of public outreach and/or programs targeted at girls in STEM, and contact details for three references who can attest to the scientists outreach experience. File size limited to 10MB.*