STEM Mentor Volunteer Application
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Last Name *
First Name *
Pronouns
Email Address *
Mailing Address (Street, City, State, Zip) *
Cell Phone *
Home Phone (If different from above)
How did you learn about the STEM Mentor Volunteer Program? *
Can you make yourself available for two 45-60 minute volunteer sessions per month during the academic school year? Candidates who respond "no" may be eligible to volunteer as a substitute mentor on an as available or as needed basis and will still complete the mentor training requirements. *
Please mark time periods when you would be available to meet virtually via video chat with a student. *
Required
Demographics
We may use this information after the interview process for pairing mentors with students.
What race/ethnicity/nationality do you identify with?
What gender do you identify with?
What languages do you have conversational fluency in?
Education
Complete all that apply
2-Year or Associates Degree (Major and Institution)
4-Year or Bachelors Degree (Major and Institution)
Graduate Program (Major, Degree, Institution)
Vocational School/Professional Certificate (Program, Institution)
Career and Interests
What is your current/most recent Science, Tech, Engineering, Math (STEM) related position? *
Who is your employer for the above position? *
Briefly explain the role of your position. What do you do at work? *
List any previous work, community, or volunteer experience you have serving teen or pre-teen youth.
Middle School STEM covers a variety of disciplinary ideas. There is no need to be a content expert in all areas to be an excellent mentor. Please check the subject area(s) of greatest interest to you. *
Required
Why are you interested in volunteering as a STEM Mentor? *
Name 3 skills or qualities that would contribute toward your success as a STEM Mentor. *
Background Clearance
Mentors will be required to complete an online background clearance process following the interview and reference check. The following information will be needed:
Full, legal first and last name (even if same as at top of application) *
Email you would like to use for background check *
Date of Birth *
MM
/
DD
/
YYYY
Two Personal or Professional References (No family members please.)
Reference 1 Name *
Reference 1 Email address *
Reference 1 Phone number *
Reference 1 How they know you *
Reference 2 Name *
Reference 2 Email address *
Reference 2 Phone number *
Reference 2 How they know you *
Optional: Is there any additional information you would like the STEMCorps team to know about you?
I understand the risks present in volunteer duties and freely assume those risks and agree to release CuriOdyssey, its officers, agents and employees from and against all claims for injury, loss, or danger to me as a result of such duties. *
I understand completing this application does not guarantee that I will be selected as a mentor and/or paired with a mentee. CuriOdyssey is not obligated to provide a reason for accepting or not accepting any particular applicant into the STEMCorps Mentoring program. *
I grant my permission for CuriOdyssey to use photographs and/or videos containing my likeness. These photographs may be used in CuriOdyssey programs publicity, newsletters, social media, marketing and development pieces, and for other promotional purposes. *
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