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!
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)
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
Most important
Second most important
Third most important
Q4: If you mentioned "geographic location", please specify location.
Q5: If you mentioned "fluency in foreign language" above, pleaseindicate 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 & 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?
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?
Q20: Do your parents use e-mail at home?
Q21: Do your parents use the Internet at home?
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?
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
a) Choosing a college--
Very interested Somewhat interested Neutral Not interested at all
b) Financial aid--
c) Staying at home versus going away to college--
d) Perceptions of what jobs or majors are good for you--
©1996 Education Development Center, Inc.
