In2science

Registration form

Become an In2science Peer Mentor

Personal Details

First Name: *

Family Name: *

Gender: *

If you are fluent in any language(s) other than English, please indicate language(s)

Other languages spoken

Semester address: * (number and street)

Suburb/town: *

Post Code: *

Phone: *

Mobile: *

University Email: *

Transport: *

Do you have a current Working With Children check?

Current WWC: *

If "Yes" enter Card No:

University Details

University: *

Campus: *

Student category: *

Year level in 2013: *

Degree program: *

Major(s): *

In2science Program - Required Information

I am willing to mentor in the following subjects (remember that schools tend to teach General Science up to Year 10 - usually on a topic rotation)*Hold the Ctrl key and left-click to select multiple subjects

Preferred Year Level to mentor: *

What school did you attend for VCE?: *

Would you consider mentoring at your old school (if it is one of our partner schools)?: *

What days are you available to mentor in 2013? Include the times you are free from and till: *

Monday: AM: PM:
Tuesday: AM: PM:
Wednesday: AM: PM:
Thursday: AM: PM:
Friday: AM: PM:

Outline your reasons for applying to the In2science Program: *

Please give details of the skills and qualities that you will bring to the role: *

In2science

Registration form

Become an In2science Peer Mentor

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