Mentor Questionnaire   

General Information (Note: will be listed on STAS website)

Name
Title
Organization
Address
Telephone
Fax
E-Mail
Website
Short (2-3 sentences) description of work or science interest:

Area(s) of expertise (check all those that apply)

	Aerospace		Forestry
	Agriculture		Geology and/or mining technology
	Astronomy		Horticulture
	Automotive		Human Medicine (incl. pharmacy, physiotherapy, etc.)
	Biology		Information Technology
	Biotechnology		Manufacturing Technology
	Chemistry		Mathematics
	Computer Science		Nutrition
	Ecology and Environment		Oceanography
	Energy Technology		Physics
	Engineering		Psychology and Behaviour
	Fisheries and Aquaculture		Telecommunications
	Food Sciences		Veterinary Medicine (incl. pharmacy, physiotherapy, etc.,
	Other (Please Specify)

SUMMARY:                                      A Mentor Activity may include:    

1)                  Answering questions related to expertise   

2)                  Mentoring sessions with student(s) (small groups or one-on-one discussion sessions about expertise or science projects.  Help hive a student some direction or resources to enhance their learning experience.    

3)                  Mentoring sessions with teacher(s) (small groups or one-on one discussion sessions about expertise, building teaching confidence in subject area).    

4)                  Classroom Presentations (on expertise, research and/or a prepared presentation at the request of a teacher).    

5)                  Education Resources (slides, posters, lesson plan that may be lent out for teaching purposes.    

6)                  Judge at Science Fairs   

7)                  Lead Workshops for Teachers (if interested in providing aid with content and expertise when Department of Education develops curriculum and resources for schools).    

8)                  Field Trips.    

START HERE!  Select the Mentor Activity (or Activities) in which you would like to partake from the following questions.  Note.  Mentoring sessions are at your convenience.    

1.         Answering Questions related to area(s) of expertise   

 

By what means would you prefer to answer questions?

No Preference

Telephone                Fax              E-Mail                     Mail

In Person                 By Video Conference                      On-line (net-meeting)

2 - 3.  Mentoring Sessions with Students and Teachers   

 

Are you available for mentoring sessions with students?   Yes             No Are you available for mentoring sessions with teachers?   Yes             No

If yes at what level?  High School  Intermediate  Elementary  All grade levels

How many people do you feel comfortable mentoring in sessions?  One-on-One  Small Groups (<5)  Large Groups (>5)

4.         Classroom Presentations (view appendix 1 for grade level science curriculum)   

 

Are you available to do classroom presentations?   Yes             No (If selection is NO, continue to Question 6)	I will give classroom presentation on my area of expertise for the following grade level(s):   All Grade Levels   High School   Intermediate   Elementary
If you have prepared classroom presentation in the past, please give a description (including title, length, type of presentation, age group most suited for, etc.)

5.         Education Resources   

 

Do you have resources available for students?   Yes             No Do you have resources available for teachers?   Yes             No

If yes, what type?  Lesson Plan             Posters  Brochures                Videos  Multimedia Presentations  Other (please specify) In which language?  English                     French

6.         Science Fair Judge   

 

Are you available to judge for science fairs?                    Yes             No

7.         Lead Workshop for Teachers   

 

Are you available to lead workshops for teachers?          Yes             No

8.         Field Trips   

If you have a suitable educational field trip or outing for students, please complete appendix 2.   

9.         Mentor-Language   

 

In which language(s) can you Mentor?  English                     French

10.       Mentor-Travel or Receive   

 

Are you willing to travel for mentor sessions?   Yes             No If yes, within which area/  Prince  Queen  Kings  All Counties  Other (Please specify)

Are you willing to accommodate mentoring sessions? (Have students/teachers come to you for mentoring).    Yes             No

11.       Time Available   

 

Dates (year-round, etc.)

Other notes:    

Please continue to appendix 1 to check off where school science curriculum links with your area(s) of expertise.  Please continue to appendix 2 if you have a field trip you would like listed on the STAS site.    

Thank you for becoming a STAS mentor!