Thank you for your interest in the FUTURES program! FUTURES is a STEM outreach program that empowers community college faculty, staff, and students to connect with their local community through sharing their personal stories. Selected FUTURES participants will receive: Workshops that help hone their skills in science communication and storytelling Professional development opportunities Opportunities to network with professionals and connect with their community A modest stipend Swag This program consists of the following commitments: Complete two workshops Complete at least one consultation Develop a personal story Uploading your personal story to the FUTURES FlipGrid Participate in at least one virtual or in-person outreach event Complete program evaluations Depending on the location, this program will take roughly a year to complete. Most participants complete this program within a semester. To apply, please provide the following information: Community College Affiliation Community College Affiliation Please select which NC Community College you are affiliated with * - Select -Alamance Community CollegeAsheville-Buncombe Technical Community CollegeBeaufort County Community CollegeBladen Community CollegeBlue Ridge Community CollegeBrunswick Community CollegeCaldwell Community College and Technical InstituteCape Fear Community CollegeCarteret Community CollegeCatawba Valley Community CollegeCentral Carolina Community CollegeCentral Piedmont Community CollegeCleveland Community CollegeCoastal Carolina Community CollegeCollege of The AlbemarleCraven Community CollegeDavidson County Community CollegeDurham Technical Community CollegeEdgecombe Community CollegeFayetteville Technical Community CollegeForsyth Technical Community CollegeGaston CollegeGuilford Technical Community CollegeHalifax Community CollegeHaywood Community CollegeIsothermal Community CollegeJames Sprunt Community CollegeJohnston Community CollegeLenoir Community CollegeMartin Community CollegeMayland Community CollegeMcDowell Technical Community CollegeMitchell Community CollegeMontgomery Community CollegeNash Community CollegePamlico Community CollegePiedmont Community CollegePitt Community CollegeRandolph Community CollegeRichmond Community CollegeRoanoke-Chowan Community CollegeRobeson Community CollegeRockingham Community CollegeRowan-Cabarrus Community CollegeSampson Community CollegeSandhills Community CollegeSouth Piedmont Community CollegeSoutheastern Community CollegeSouthwestern Community CollegeStanly Community CollegeSurry Community CollegeSystem OfficeTri-County Community CollegeVance-Granville Community CollegeWake Technical Community CollegeWayne Community CollegeWestern Piedmont Community CollegeWilkes Community CollegeWilson Community CollegeOther/Not listed Contact Information Contact Information First Name * Last Name * Email Address * Re-enter Email Address * Alternative Email * Please share your personal (non-work/school) email. [e.g. Kelvin.Scientist@gmail.com] Confirm Alternative Email * Please confirm your personal (non-work/school) email. [e.g. Kelvin.Scientist@gmail.com] Phone Number * xxx-xxx-xxxx Application Application Information Why are you interested in this program? * Please share a short story about your experience with STEM or share how STEM has influenced your life. * 300 words or fewer Have you participated in public outreach before? If so, what did you do? Select all that apply Visited schools Media interviews Blogging/social media Presented to elected officials Informal public education Other If you selected "Other", please describe Please confirm the following: * I will be able to participate in two workshop sessions I will be able to participate in at least one consultation I will be able to complete at least one outreach activity I will communicate with program staff in a timely manner Education and Occupation Education/Occupation Are you currently a student? * Yes No What program are you enrolled in? * Please briefly describe your program * 100 characters or fewer When will you complete your program? * What do you plan to do when you complete your program? * Attend college/university Start a career Not sure What is the highest degree or certification you have earned? * A.A B.A./B.S. M.A./M.S. Ph.D M.D. Other If you selected "Other", please describe What field is your highest degree/certification in? * Science Technology Engineering Mathematics Other If you selected "Other", please describe What is your role within your affiliated community college? * Faculty Staff Alumni What department do you work in? * Where do you work? * What is your job title? * Please briefly describe what you do for a living * 100 characters or fewer Personal Information Personal Information Age * 15-17 18-22 23-29 30-44 45-59 60+ Gender * With which of these groups do you identify? * The FUTURES program prides itself on its diversity and having our scientists represent the diverse population of North Carolina. African American/African Caucasian/European Hispanic/Latino American Indian/Alaska Native Native Hawaiian/Other Pacific Islander Middle Eastern South Asian/Indian East Asian Prefer not to answer Other What t-shirt size do you wear? * - Select -XSSMLXLXXLXXXL Do you have any dietary restrictions? If so, please list them here. Do you have any allergies? If so, please list them here. Do you have any special needs or considerations that we need to know about? If so, please elaborate and provide suggestions for proper accommodations. Emergency contact Emergency Contact Information Name * Phone number * Relationship * How did you learn about the FUTURES program? Website Email TV Radio Other If you selected "Other", please describe
