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* 1. Name

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* 2. Email address: 

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* 3. Role (e.g. Software developer, research assistant)

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* 4. Institute:

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* 5. Team:

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* 6. Faculty

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* 7. What was your main reason for becoming a STEM Ambassador?

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* 8. Have you completed the DBS check process? (If this has not been completed, it doesn't necessarily mean you can't do public engagement activities. Talk to the public engagement team if you'd like more information).

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* 9. Have you undertaken any STEM Ambassador activities in the last 12 months?

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* 10. We are looking for STEM Ambassadors to help with our upcoming Open Saturday events. Please let us know by ticking the box below if you would be interested in taking part:

  I'd like to do an existing activity I'd like to bring my own activity
Saturday 16th November 1 pm - 4 pm
Saturday 21st December, 1 pm - 4 pm

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