SIS Teacher Signup Form

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.



Your Name *


Contact Phone Number


Best Time to Contact


E-Mail Address


Number of Classes Participating in Presentations


Grade Range Of Participating Students

Special Needs Students


Number of Student Participants Total


Gender of student participants:

Number of Females:


Number of Males:


Number of non-binary:


Underrepresented groups (please fill out to the best of your ability; use a school % if exact numbers are unknown):

Number of students who identify as Indigenous:


Number of students with disabilities:


Number of students identified as at-risk:


Number of newcomers (within 2 years of arriving in Canada):


Desired Presenter


Desired Topics



Ideal Date of Visit

School Name


City


EmailConsent


Attachments