AR STEM Speaker Data Form

AR STEM Speaker Data Form

Personal Information

Having your personal information will help us stay in touch if you change jobs. We will NOT release this information unless you choose that you prefer to be contacted personally.
Home/Personal Address
Home/Personal Address
Street or Mailing Address 1
Street or Mailing Address 2
City
State/Province
Zip/Postal

Permissions & Agreement

I give permission for The Arkansas STEM Coalition to use the answers in this survey on their website and separate Speakers Bureau websites.
By inputting my information into this form, I understand that I am agreeing to speak on a volunteer basis as part of the AR STEM Speakers Bureau.
Would you like to subscribe to The Arkansas STEM Coalition’s e-newsletter? (We send once or twice a month and will never sell or share your information.)

Speaking Availability

How are you available to speak? (choose all that apply)
Preferred contact method? (choose all that apply)
Do you have a hands-on activity that you can bring with you?
If you don’t have a hands-on activity, would you be open to getting support to develop one or having a partner organization bring a related activity to include?
In which parts of Arkansas are you available to speak? (choose all that apply)
At what type of venues/events are you willing to speak? (choose all that apply)
What age(s) are you comfortable speaking with? (choose all that apply)
Which counties are you available to speak in? (choose all that apply)
Which cities are you available to speak in? (choose all that apply)

Demographic Information

Your Gender (choose one)
Your Age Range (choose one)
Your Race/Ethnicity (choose all that apply)

Professional Information & Networking

Maximum file size: 516MB

Please upload your bio and/or CV. If you have multiple bios (i.e. a short and long one), please upload each file separately.

Maximum file size: 516MB

Please upload your bio and/or CV. If you have multiple bios (i.e. a short and long one), please upload each file separately.

Maximum file size: 2MB

Please upload your most recent head shot. If you have multiple ones, please upload the one that you prefer we use.

Work/School Status

Are you currently working, in school, retired, or doing something else? (choose all that apply)