Scientists and Innovators in Schools Request Form

Please fill out all fields as required, or put a 0 or N/A in the text box.
Please fill out all information EVEN IF YOU ALREADY HAVE A MENTOR BOOKED AND ARE REGISTERING A SESSION.
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PLEASE NOTE: The class visit you are requesting is partially funded through a Government of Canada program aiming to equip students, including traditionally underrepresented groups, with the skills and study incentives they need to be prepared for the jobs of today and the future.  The demographic data that we are collecting as part of your request is a requirement of the funding; it helps the government administrators understand the breadth of access and the impact of Science World’s programs.

Teacher Name *


Contact Phone Number *

Contact Email Address *

Please note: the majority of SIS communications will be in email format


Best Time to Call *

Please let us know the best times to contact you by phone, or write email only in the box.

School Name *

City of School *

BC School District Number

School Postal Code *

X1X 2Y2

Number of Classes Participating in the SIS Session *

PLEASE NOTE: SIS sessions are designed for 1 class. If you wish to serve more than one class we suggest a separate request for each class to best serve the grade(s) and topic(s) being requested.

Number of Students TOTAL *

My Class would like a SIS Mentor for: *

Please choose ONE option. We will try and match for in-person sessions when possible if there is a SIS Mentor available in your area for a given topic.

Grade(s) of Participating Students *

Please check ALL that apply

Special Needs Students *

Number of Females *

PLEASE NOTE: The class visit you are requesting is partially funded through a Government of Canada program aiming to equip students, including traditionally underrepresented groups, with the skills and study incentives they need to be prepared for the jobs of today and the future.  The demographic data that we are collecting as part of your request is a requirement of the funding; it helps the government administrators understand the breadth of access and the impact of Science World’s programs.

Number of Non-Binary *

Number of Males *

Number of Students who identify as Indigenous Peoples *

PLEASE NOTE:
Please fill out to the best of your ability; use of school % is requested if exact number unknown.

The class visit you are requesting is partially funded through a Government of Canada program aiming to equip students, including traditionally underrepresented groups, with the skills and study incentives they need to be prepared for the jobs of today and the future.  The demographic data that we are collecting as part of your request is a requirement of the funding; it helps the government administrators understand the breadth of access and the impact of Science World’s programs.

Number of Students who identify as Persons with Disabilities *

Number of Students who identify as Persons of Colour *

Number of Students identified as Newcomers (within 2 years of arriving in Canada) *

Number of Students identified as At-risk *

Desired Topics *

Please choose as many topics from the list as possible. We will do our best to match you to a STEM professional who has knowledge in the general area of the topics chosen to be an inspiration for your students.

Ideal Month(s) for SIS Session *

Please indicate which months are suitable for a visit this school year (be as flexible as possible). Actual dates for visit are subject to SIS Mentor confirmation.

Email Consent for future information from Scientists and Innovators in Schools *

If you already have a session booked, or are registering a session after the fact- please insert the name of the SIS Mentor here. If not- please use n/a.

Desired Language *

SIS will try to match language requests, please be aware the vast majority of our mentors are limited to English sessions.

**Important!** --- If after finishing the survey, if you are still on this page, most likely you have not filled out some information. All fields are REQUIRED to be filled out. If you do not have an answer for a particular field, please put a 0 or n/a.