Schools

Thank you for participating in the CareerMash Role Model program.

By completing this form, you are registering to have at least one (1) technology Role Model visit your school in February or March 2012. The information you provide will be used by CareerMash to plan logistics and recognition, and will not be shared with third parties without your permission.

CareerMash will connect your Teacher Liaison with a Role Model via email in early February, and together you can determine appropriate time(s), classroom(s), and date(s) for the visit.

School Principal Name:

* Required field

Teacher Liaison First Name *

Teacher Liaison Last Name *

   Teacher Liaison email *

   School name *

   School address *

   Postal code *

   Daytime telephone number *

   Fax number

*I acknowledge information provided herein will be used by CareerMash to select a Role Model to visit my school. I have informed CareerMash herein of all barriers to my school's involvement, and understand that extracting myself from this commitment hereafter will pose considerable difficulty to CCICT and participating role models.