Be A Scientist Sign Up

Sign Up Today to Start Mentoring for "Be A Scientist"!

Need more information about "Be A Scientist"? For more questions email Darlene at BASprogram@crscience.org

Choose a lab period that you are able to commit to: You may select multiple lab periods within a session to indicate that you are available for multiple options: Willard Middle School - Thursdays and Fridays from October 17- December 6 with No sessions 10/31-11/1 and 11/28-11:


First Name:
Last Name:
Legal Name: (If different from above)
Birthdate: (mm/dd/yyyy)
Work Email
Personal Email:
Street Address:
City:
State:

Zip:

Phone:

LinkedIn Profile:

Department or Company: (e.g. Chemistry)

Lab Group: Please include professor first and last name(if applicable)

Please check this box if your research of lab is affiliated with the Berkeley Lab:

Title:

Other Title:

Expected Graduation Year: (if applicable)

Gender: (collected for grant reporting purposes only)

Race / Ethnicity: (collected for grant reporting purposes only) (select all that apply: hold down 'Ctrl' on a PC or 'Command/Apple' on a Mac)

Other Languages Spoken (besides English): (select all that apply: hold down 'Ctrl' on a PC or 'Command/Apple' on a Mac)

Please select the time that you are available for your MANDATORY 2-hr training. All trainings will take place on Zoom

Do you have any experience working with students who have special needs (e.g., ADHD, learning disability, autism)? Please describe:

Please share additional information about yourself to better match you with your student groups! Please include hobbies, interests, and life experiences that students may relate to. (This is also the place to indicate a preference for a lab period or if you would like to participate in multiple lab periods).

How did you hear about the Be A Scientist program? (select all that apply)

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