ACS Science Coaches
Program Participation Application
Please complete this form so that you and your partner teacher
will be considered for the ACS Science Coaches program.
If we send a small package to you, where would you prefer to receive it?
Please provide the address where you would like to receive the item. If you have chosen to your workplace. Please include the name of the company, business, or university.
Country, if not USA
Please state your institution or workplace name.
Please state your work title.
Your Email Address
Confirm Email Address
About the Teacher
Teacher's Email Address
Please confirm Email
Why did you select this school?
I know the teacher
I have worked with this teacher previously
My child or grandchild is in the class
Proximity to my home or work
Underserved school or community
Opportunity to help students do advanced science
Why did you select this teacher?
My child is in this teacher's class.
The principal recommended this teacher.
Another teacher or parent suggested this teacher.
I have assisted this teacher for more than one year.
We partnered together last year.
We are personal friends.
We are related to one another.
We are married to one another.
What types of things would you like to do to help the teacher this school year?
Please check all that apply.
Help find demonstration ideas
Help with student laboratory activities
Help plan lessons
Advise on safety issues
Find or evaluate science resources
Answer science questions from students
Present science lessons
Provide career information
Assist with a special project
Mentor a team or science club
Whatever the teacher needs
Describe the experience you have working with students and teachers in a school setting.
Check all that apply.
This will be the first time I have volunteered in a school.
I have volunteered in a school a few times.
I volunteer in a school frequently.
I have worked with students in informal settings.
I work with students at the college level.
I teach pre-service teachers.
I used to be a teacher.
I am considering a career in teaching.
What other educational outreach do you plan to do this school year?
How do you think your participation in the ACS Science Coaches program will benefit the teacher and students?
What is your motivation for participating in the ACS Science Coaches program?
Indicates Response Required