SEP Mentor Sign Up

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SEP Mentor Sign Up
First Name*
Last Name *
Nickname or Preferred Name
Home Address
Street Address
Street Address Line 2
City
State
Zipcode
Work Site Organization*
Fred Hutchinson Cancer Center, University of Washington, Seattle Children's Hospital, Shoreline Community College
Lab Principal Investigator or Director*
Ex: Nina Salama, HICOR
Work Address
Street Address
Lab Room Number and/or Mailstop
Street Address Line 2
City
State
Zipcode
Primary Contact Email*
Primary Contact Phone*
Position*

Graduate studentPost-doc/Research AssociateStaff ScientistNon-scientific StaffScientific StaffFaculty/PIClinical Staff/FacultyOther
If you selected 'Other' for Position, please specify here:
Highest Degree Completed*

High School DiplomaAssociate's Degree (e.g., AA, AS)Bachelor's Degree (e.g., BA, BS)Master's Degree (e.g., MA, MS, MSc)Doctoral Degree (e.g., PhD, EdD, MD, JD)Professional Degree (e.g., MD, JD, DDS, DVM)Vocational/Technical Certificate
Are you a current student of the UW/Fred Hutch Molecular and Cellular Biology (MCB) Program participating in the Science Education TAship?*

YesNo
Did you have an SEP teacher when you were in middle or high school?*

YesNoNot sure
If you answered Yes above, please share the teacher's name.
If you answered Yes above, please share the school.
Have you mentored an SEP teacher previously?*

YesNoNot Sure (please explain)
If you answered Not Sure above, please explain below.
Past mentors have noted that hosting a pair of teachers can be easier than a single mentee. How many teachers are you willing to take?*

12Other
Past mentors have also found that sharing mentoring duties with another member of their lab can be productive. If you would like to do this please enter the name and email address of your co-mentor.
Co-mentor name
Co-mentor email
In a couple of sentences, please summarize your current research interests in jargon-free language that an educated layperson would understand. We will share this information with your teachers. *
In a few sentences, please share why you are interested in mentoring an SEP teacher or pair of teachers.*
Do you work in a dry lab or expect to only be doing dry lab work this summer?*

Yes - I expect to be doing dry lab work this summerNo - I predominantly do wet lab workI don't know
What T shirt size do you prefer?*

XXXLXXLXLLMSXS
Do you have any dietary restrictions. (This is for the Teacher/Mentor dinner in late June for mentors and teacher in the Seattle area). Please select all that apply.*

VegetarianVeganGluten FreeDairy FreeNut freeHalalKosherOther
Are you 18 years or older?

YesNo
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