Registration (scientist)

Use this form to register as a scientist.

If you like, you can nominate a particular school to work with - either from the list of unmatched schools or any other school that you are interested in. If you'd like to nominate a school, please include the school name and location in the section that asks about your preferred school or style of partnership.

If you don't nominate a specific school, we will select an appropriate school for you based on the other information you provide in this form.

For more details about Scientists in Schools, read the information for scientists.

* = Mandatory field

Title          
* First name
* Surname
Gender M    F
Position
Department
* Organisation
Other organistions
* Work postal address
 
* Town/suburb
* State   * Postcode
* Phone (Wk.)         Mobile
Fax
Email
* With which area(s) and year level(s) would you like to help teachers?
Read more information about the subject areas
  Year level(s) of interest

Subject area(s)
of interest

Lower
Primary		 Middle
Primary		 Upper
Primary		 Junior
Secondary		 Senior
Secondary
Earth & Space
Living Things
Energy & Force
Matter
Mathematics
Engineering & Technology
Working Scientifically
Please tell us about your preferred school or style of partnership
Current discipline or specialty (eg biochemistry,
civil engineering, obstetrics)
* Highest qualification
* Year of qualification (YYYY)
Professional associations
Age range
* Have you ever had
a police check done? 		Yes    No
If yes, when was your
last police check? 		(MM/YYYY)
Around which location would you like to be partnered?  
Would you be willing to travel to visit a school? (If selected, your travel costs would be covered by the SiS project). Yes    No
Would you be happy to work in a partnership with no face-to-face contact (for example via teleconference or email)? Yes    No
Please describe any school projects you are currently involved with (including the school name if possible).
Where did you hear about Scientists in Schools?
My supervisor supports my involvement in this project Yes    No    Not applicable
Supervisor's first name
Supervisor's last name
Supervisor's email
  I have read and accepted the terms & conditions in the legal notice New Window.


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