BASIS Sign up – Genentech

BASIS Sign up – Genentech

Thanks for your interest in volunteering to do science eduction outreach with Communty Resources for Science.

Please fill in the registration form below and our Program Manager will reach out to follow up with you.

 

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*First Name:
*Last Name:
Legal Name: (If different from above)
Birthdate: (mm/dd/yyyy)
*Work Email
Personal Email:
Street Address:
City:
State:
Zip:
*Phone:
Title
*I am interested in...	leading virtual Bay Area Scientists Inspiring Students (BASIS) lessons serving as a Science Ambassador, making 4 visits to a class throughout the semester
Do you plan to volunteer together with colleagues? If so please list names and/or department here.
Gender: (collected for grant reporting purposes only)	Male Female Non-Binary Transgender Other Prefer not to say
Race / Ethnicity: (collected for grant reporting purposes only) (select all that apply: hold down 'Ctrl' on a PC or 'Command/Apple' on a Mac)	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander Hispanic / Latino White Mixed Race Other Prefer not to say
Many of the schools we serve have "language immersion" classes. We occasionally receive requests for science presentations in languages other than English. Would you be comfortable presenting a BASIS lesson in any of the following languages? (select all that apply: hold down 'Ctrl' on a PC or Command/Apple on a Mac)	Spanish Mandarin (Chinese) American Sign Language Cantonese (Chinese) French German Korean Japanese Tagalog Greek Arabic Italian

CRS Photo Policy: To document our work supporting science education for the community and funding agencies, CRS/BASIS at times take photos and/or videos of our programs in action. We do not include volunteer or student names when publishing these images online or in print. By participating as a BASIS volunteer, you consent to CRS use of your photo or video image, unless you expressly opt out in writing. If you do NOT consent to CRS use of photo/video of you, please send a message to teach@crscience.org