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STEMCAP Y-I-C Center Partner Request Form
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* Indicates required question
Full Name
*
Your answer
Position
*
Teacher
Administrator
Staff Member
Other:
Youth-in-Custody Facility:
*
Your answer
Facility Location
*
Your answer
Average Class Size
*
Your answer
Do you (or you facility) teach male or female students?
Male
Female
Both
Clear selection
How long are your class periods?
45-50 minutes
60-70 minutes
70-90 minutes
Clear selection
When is the ideal time of day for a STEMCAP presentation?
Morning
Afternoon
Both
Clear selection
Are there any days of the week that work best for guest speakers?
Your answer
What types of programming are you in interested in (check all that apply):
Science Right Now Presentation
Art-Science Workshop
Objects From Nature
Conservation Project
Mission STEMCAP
Portal to Science Virtual Lab Tours
Are you looking for on-going programming or a single presentation?
On-going
Single presentation
Clear selection
Why are you interested in working with STEMCAP?
Your answer
What types of security protocols and material restrictions does your center have? Explain.
Your answer
Have you worked with University of Utah in the past?
Yes
No
Clear selection
Do you currently work with other community partners or volunteer programs?
Yes
No
Clear selection
How id you hear about us?
Your answer
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