1. Name*
2. E-mail Address*
3. Primary Telephone*
4. Alternate Telephone
5. Current Position* -- Select One -- Graduate Student Post-Doc
6. Department*
7. University* -- Select One -- Duke Univ North Carolina State Univ Univ of North Carolina at Chapel Hill Wake Forest Univ NIEHS North Carolina Central Univ North Carolina A&T State Univ UNC - Charlotte

*How much time would you be willing to volunteer on Friday, April 25th? (including travel time)
AM PM
Both No Preference

 

*Will you have access to a car on Friday, April 25th?
Yes No

 

*Are you interested in meeting with a small group of students over breakfast of lunch to discuss biomedical science careers?
Yes No

 

*Do you have friends or family in North Carolina that you would be willing to stay with prior to DNA Day. Then indicate their location below. This will allow us schedule visits to more remote areas of North Carolina.
Yes No If Yes, Location:

 

If you have a partner preference, please provide the name of your preferred partner. (Make sure volunteer information is compatible with your partner’s information)

Below are a list of DNA Day modules for 2008. Check only modules that you would NOT be comfortable teaching.

(For a module description, click on the module's name)

1. Human Genome Project Module
2. Biotechnology and Farming Module
3. Genes and Disease Module
4. Cystic Fibrosis Module
5. Forensics Module
6. Single Nucleotide Polymorphisms (SNPs) Module
7. The Chemistry of DNA Module
8. Pharmacogenomics Module
9. Ethic, Legal, and Social Implications (ELSI) Module

If you require special accommodations please indicate so below. Also, address any additional comments you have: