* 1. First Name

* 2. Last Name

* 3. Address:

* 4. City:

* 5. Zip Code:

* 6. Home Phone:

* 7. Cell Phone:

* 8. Email:

* 9. Best time to be reached:

* 10. Age:

* 11. Grade in Fall 2014 (must be entering 10th grade or above):

* 12. School:

* 13. Why are you interested in being a STEM Educator for the Library?

* 14. What skills or abilities do you bring to this position?

* 15. Please describe experience you have working with children.

Volunteer Experience

* 16. Organization:

* 17. Type of work performed:

* 18. Length of time at organization:

Work Experience

* 19. Employer:

* 20. Date employed:

* 21. Business address:

* 22. Position:

* 23. Length of employment:

Personal Reference

* 24. Reference name:

* 25. Reference phone:

* 26. Reference address:

School/Business/Volunteer related reference:

* 27. Reference name:

* 28. Reference phone:

* 29. Reference address:

In case of an emergency:

* 30. Emergency contact name:

* 31. Emergency contact phone:

* 32. Teen STEM Educators will be leading programs at various library locations. Please check all of the locations for which you are interested and available:

* 33. Training to be a Teen STEM Educator is required. Please check the date you will attend training:

* 34. If I am younger than 18, I understand that this volunteer position requires the signature of a parent or guardian before I can begin.

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