Telementoring 1996-97

Student Application

Welcome to the Telementoring Project! As part of this project, you will be matched with a mentor who is a professional woman in a scientific or technical career. The information you provide here will help us find the best mentor match for you, so please answer the following questions honestly and completely. Thank you!

Basic Information

First Name:
Last Name:
E-mail Address:
State:	Alabama Colorado Iowa New Mexico New York Tennessee Select one
Your School:
Name of your AiS teacher:
Your Age:
Your Grade:
Home Address:
Your Race/Ethnicity:	Asian/Pacific Islander Hispanic/Latina Black/African-American Native American White (non-Latina)

Finding You a Mentor

Q1, 2, 3: What are the three most important things that you would consider when selecting a mentor?

Most important	Select One Certain Career Fields (see below) Hobbies/Interests Same Race/Ethnicity Different Race/Ethnicity Fluency in Foreign Language Geographic Location Lives/works in small town Lives/works in city
Second most important	Select One Certain Career Fields (see below) Hobbies/Interests Same Race/Ethnicity Different Race/Ethnicity Fluency in Foreign Language Geographic Location Lives/works in small town Lives/works in city
Third most important	Select One Certain Career Fields (see below) Hobbies/Interests Same Race/Ethnicity Different Race/Ethnicity Fluency in Foreign Language Geographic Location Lives/works in small town Lives/works in city

Q4: If you mentioned "geographic location" above, please specify location.

Q5: If you mentioned "fluency in foreign language" above, please indicate which language.

Q6a: What career fields are you interested in? (Check all that apply).

Physics & Astronomy
Mathematics
Computational Science
Computer Programming/Software Development
Biomedical Science (e.g. medicine, forensic pathology, genetics)
Chemistry
Earth Science (e.g. geology, oceanography, meteorology)
Social Science & Psychology
Humanities (e.g. art, literature, music)
Business
Engineering
Other:

Q6b: If you selected Engineering, which types are you considering? (Check all that apply).

Aerospace
Biomedical
Chemical
Civil
Computer
Electrical
Environmental
Industrial
Mechanical
Software

Q7: What are your hobbies and interests?

Q8: What dreams and aspirations do you have for yourself beyond high school?

Q9: What is your favorite subject in school?

Computer Science
Mathematics
Physics
English/Literature
Physical Education
Social Studies (History, Political Science, Law)
Humanities (Art, Drama, Music)
Biology
Foreign Languages
Chemistry
Technology
Other:

Q10: How often would you like to "talk" with a mentor on-line?

More than once a week
Once a week
Once every 2 weeks
Once a month
Other:

Q11: What would you like to talk about with your mentor? (Check all that apply).

College Preparation

Financial planning for college

Applications

Course selection

Study skills

Information about college life

Resources & Networks

Tutoring

Accelerated and/or summer programs

Internships

Supporting organizations

Career Awareness

Career opportunities

A day in the life of a woman in science

Interviewing

Resumes and references

Diversity Issues

Opportunities for students of color

Affirmative action

Getting along in diverse groups

Prejudice and racism

Personal Development

Balancing family and work

Sexual harassment

Self-image and self-confidence

Time management

Other:

Q12: What do you hope to gain by participating in the Telementoring Project this year?

More About You

Q13: Are you thinking of pursuing a career in science, engineering, or computing? Please tell us why or why not.

Q14: Think about your experiences with mathematics. Have they been fun? Anxiety producing? How do you feel about math now?

Q15: On a scale of 1 to 5 (where 1=not anxious at all and 5=extremely anxious), how anxious do you feel about mathematics?

1 2 3 4 5

Q16: How do you feel, as a female, working with others (males and females) in your science and computing classes? (For example, do you feel comfortable, anxious, isolated, welcome, etc.)?

Q17: How do you feel about using computers? (Do you enjoy them, fear them, use them only when you have to, etc.)? Please tell us what makes you feel this way.

Q18: Do you have access to e-mail at home?

Yes No

Q19: Is there anything else you would like to add about yourself or your interests?

Involving Your Parents & Family

Q20: Do your parents use e-mail at home?

Yes No

Q21: Do your parents use the Internet at home?

Yes No

Q22: How willing would you be to teach your parents or other family members about e-mail and the Internet?

Very willing
Somewhat willing
Neutral
Not willing

Q23: How willing would you be to bring your parents to a Telementoring event at school in which they learn about girls and science?

Very willing
Somewhat willing
Neutral
Not willing

Q24: How interested would you be in involving your parents in a discussion about:

a) Choosing a college

Very interested
Somewhat interested
Neutral
Not interested at all

b) Financial aid

Very interested
Somewhat interested
Neutral
Not interested at all

c) Staying at home versus going away to college

Very interested
Somewhat interested
Neutral
Not interested at all

d) Perceptions of what jobs or majors are good for you

Very interested
Somewhat interested
Neutral
Not interested at all

Thank you for completing this application!