Inforum Michigan

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inSTEM Role Model Volunteer Form
inSTEM Volunteer *	inSTEM Volunteer
First Name *
Last Name *
Title *
Company Name *
Email *
Phone Type *
Phone *
Phone Type 2
Phone2

Tell us about yourself.
Industry
Occupation
Years of Professional Experience
Undergraduate Degree
Master's Degree

Volunteer Preferences
Types of Volunteer Activity Perferred	Panelist Hands-on activity Role Model Speaker All of the above
Preference for Age of Kids	Elementary Middle School High School College All of the above
Day of the Week	Sunday Monday Tuesday Wednesday Thursday Friday Saturday Monday thru Friday Any day of the week
Time of Day	Morning Afternoon Evening All of the above

Location
Region	Southeast Michigan West Michigan All of the above
Travel Distance
Zip Code - Home
Zip Code - Work
Additional Comments

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