inSTEM Role Model Volunteer

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inSTEM Role Model Volunteer Form

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inSTEM Volunteer *

inSTEM Volunteer

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First Name *

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Last Name *

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Title *

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Company Name *

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Email *

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Phone *

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Phone2

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Tell us about yourself.

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Industry

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Occupation

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Years of Professional Experience

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Undergraduate Degree

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Master's Degree

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Volunteer Preferences

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Types of Volunteer Activity Perferred

Panelist

Hands-on activity

Role Model

Speaker

All of the above

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Preference for Age of Kids

Elementary

Middle School

High School

College

All of the above

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Day of the Week

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Monday thru Friday

Any day of the week

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Time of Day

Morning

Afternoon

Evening

All of the above

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Location

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Region

Southeast Michigan

West Michigan

All of the above

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Travel Distance

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Zip Code - Home

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Zip Code - Work

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Additional Comments

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