Survey of Industry Partners 
Interest in Participating in the San Mateo Biotechnology Career Pathway (SMBCP)

Place check here	Would you be interested in?	
	Having a SMBCP student shadow (follow) you at your jobsite for a day	
	Acting as a mentor to student entering the SMBCP, including email and phone correspondence and occasional visits to the industry site	
	Acting as a mentor/supervisor to an unpaid, student intern in a summer laboratory internship	
	Helping organize a field trip and tour of your workplace  
	
	Giving tours of your workplace to groups of students	
	Giving a lecture on a science topic in your area of interest to (check one or both):
___ A class (35 students)   
___ Several classes (100+)	
	Giving a lecture to specifically discuss (check one or more):
___ Science careers           
___ Minorities in science
___ Women in science        
___ Education needed for science careers
___ Your education and workplace experiences
___ Your research or work projects	
	Being a member of the San Mateo Biotechnology Career Pathway Advisory Committee
	
	Helping organize a surplus supply donation (equipment, supplies, reagents) program at your jobsite	
	Helping a biotechnology student with a science project or with experimental research	
	Going to a classroom to help a teacher with a laboratory activity
	
	Planning a science lesson(s) and/or laboratory activities with a teacher
	
	Teaching a lesson to a science/biotechnology classes
	
	Helping with or co-authoring a grant
	
	Being interviewed by a student interested in careers in biotechnology
	
	Being a member of a panel discussion on biotechnology careers or bioethics
	
	Other (please specify):	

Thank you very much for taking the time to fill in the survey.  Please fax or send it to:

Ellyn A. Daugherty, Jimmy Ikeda, Marvin Gin, Biotechnology Instructors, San Mateo High School
506 N. Delaware St., San Mateo, CA  94401	 Phone 650-558-2389, FAX # 650-558-2358

Your name______________________________
Title______________________ Your company _________________________
Phone #_______________ Fax #_______________
email ________________________________________________