Address:
             
City:    State:    Zip:

Professional:
Occupation / Job Title:

Company:

Address:
             
City:    State:    Zip:

I prefer to be contacted:

At home phone - -

At work phone   - -

By e-mail

Through company contact person
          Name:  
          Phone: - -
          Fax:      - -

Time Commitment: Frequently / Occasionally

Grade Preference: K-2 / 3-5 / 6-8 / 9-12

Group Size: Small group / Class

Place: At school / At work site

Geographic preference by high school area: (please check all that apply)

No Preference Bethesda-Chevy Chase Blair Blake Churchill Clarksburg Damascus Einstein Gaithersburg Northwood

Walter Johnson Kennedy Magruder Richard Montgomery Northwest Paint Branch Poolesville Quince Orchard

Rockville Seneca Valley Sherwood Springbrook Watkins Mill Wheaton Whitman Wootton

Interest Profile
Please indicate, by checking the appropriate boxes below,
how you would like to be involved with Montgomery County Public Schools:

	Speaker	A person who discusses, illustrates, or demonstrates a predetermined topic with a small or large group of individuals on an occasional basis at school
	Tutor	A person who instructs an individual or small group of students on topics or concepts that need reinforcement on a regular basis at school
	Mentor	A person who discusses a topic; suggests reading materials, ideas for further work or other resources; and may serve as a role model by working with a student by telephone, e-mail, or in person on a regular basis either at school or the work site
	Consultant	A person who provides professional advice or services to an individual or group on a topic, program or project (e.g., a science fair project) or by telephone, e-mail, or in person, on an occasional basis for the duration of the project
	Judge	A person with sufficient knowledge to decide on the merits of a project, contest entry, or activity for a competition on an occasional basis, usually at school
	Career Interview	A person who provides students with information about a particular career or occupation in a structured interview conducted by the student at the work site, at school, by telephone, or e-mail.
	On-Site Sponsor	A person who provides supervision for students at the work site for short term (shadowing) or long term (internship) experiences

Briefly describe the specific expertise you are willing to share
or a topic you are willing to discuss:

Yes

I understand my name and interest profile information will be included in the Connection Resource Bank.