I am...
Interested in being a CareerMash Role Model but have a non-negotiable commitment on the morning of
Contact Information:
First name *
Last name *
Organization name *
Position *
Business address *
Street Address
Unit/Floor
City
Province
Postal Code
Daytime telephone number *
Fax number
Email address *
Professional Information
Please list your college and university degrees with area of specialty and dates received (if incomplete, please indicate).
In total, how many years of technology-related work experience do you have?
CareerMash will do its best to match you with a conveniently located school, though we cannot make any guarantees. Please list your top 3 school
districts (in order of preference) for your assigned school among the following options: York, Halton, Toronto, and Peel.
Does your assigned school need to be public transit-accessible?
Yes
No
Please list any non-negotiable travel or other scheduling conflicts during the months of February-March 2012.
Experience Working with Young People
Have you had any recent experiences working with young people (e.g., children's clubs, guides, scouts, coaching, etc.)?
Yes
No
If yes, please give a few examples
Have you had any formal experience
giving presentations/teaching to children and/or teenagers?
(Please check)
If yes, please give a few examples
*Required
*I acknowledge information provided herein will be used by CareerMash to reserve a place for me at the Role Model training session, and to match me with a school
to do a presentation, both of which I am committing myself to attend. I have informed CareerMash herein of all barriers to my involvement, and understand that
extracting myself from this commitment hereafter will pose considerable difficulty to CareerMash and participating schools. If I am uncertain of my ability to
commit at this point, in lieu of checking this box I will contact CareerMash to inform them of my concerns.
Canadian Coalition for Tomorrow's ICT Skills (CCICT)