Building Leaders for Advancing Science and Technology Chaperone

Applications Due: Sunday, February 1, 2026

Welcome to the BLAST - Building Leaders for Advancing Science and Technology Teacher Chaperone Application!

Thank you for your interest in joining us as a Teacher Chaperone for BLAST, a free, three-day residential STEM experience for rising 9th and 10th grade students. BLAST is designed to introduce students who have had limited opportunities in STEM to the exciting world of Science, Technology, Engineering, and Math through engaging, hands-on activities.

As a Teacher Chaperone, you'll play a vital role in supporting our scholars throughout their residential experience. You'll help create a safe, encouraging environment while guiding students as they explore college life, participate in STEM challenges, and build connections with peers and mentors.

By completing this application, you are confirming your interest in serving as a Teacher Chaperone and supporting BLAST's mission to open doors for students eager to take their first steps into STEM.


The position for which you are applying will potentially require a background check, fingerprinting, and/or an online safety module as a condition of employment.

First Name:
Middle Name:
Last Name:
Preferred Name:
e-mail:	sample-applicant@example.com
Home Address:
	, VA
Home Phone:	( ) -
Work Phone:	( ) -
Cell Phone:	( ) -
Are you a US Citizen or Legal Permanent Resident?	Yes   No
Are you a Virginia Resident?	Yes   No
Gender:	MaleFemale

School Name:
School Address:
	, VA
Teaching License:	I hold a valid Virginia Professional Teaching License. Yes No List Endorsement areas: List subjects currently teaching:
Resume:	File Upload (PDF format only) If you do not have a PDF conversion tool you can use one of these free on-line PDF converters: PDF Online - PDF Converter. To ensure that your PDF files may be properly included in your application, please ensure that they are not protected via encryption, a password, a signed certificate, or in any other manner.

As part of your application packet, you are required to provide two letters of recommendation from current or former supervisors, department chairs, school administrators or someone who can attest to your professional qualifications. Incomplete applications will not be considered.

Reference #1 Name: Title: Institution: Phone: email: email confirm:   Reference #2

Once you have submitted your application, the system will email these people instructions on how to submit an on-line letter of recommendation on your behalf. Please inform them that they will be receiving an email from notices@spacegrant.net with these instructions. Note: It is the responsibility of the applicant to follow up with these people to ensure the recommendation is submitted electronically by the Wednesday, February 4, 2026 deadline.

Please rank your session preferences by selecting from the options below. Note that if you only select one session, you will only be considered for that session.