Science Education Mentor/Volunteer Interest Form

Mentor/Volunteer Interest
Science Education Mentor/Volunteer Interest Form

Thank you for your interest in volunteering or mentoring for Science Education, please complete the form below. Submitting this form indicates interest only and is non-binding, a member of our team will contact you after your submission.

If you have any questions please contact GG at ggoode@fredhutch.org.
First Name
Last Name
Nickname or Preferred Name
Pronouns

She/Her/HersHe/Him/HisThey/Them/TheirsOther
Email
example@example.com
Position

Graduate studentPost-docStaff ScientistNon-scientific StaffScientific StaffPIClinical Staff/FacultyOther
What is the highest degree you have earned?

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 CertificateOther
What is your primary worksite?

Fred Hutchinson Cancer CenterUniversity of WashingtonSeattle Children's HospitalOther
Lab Principal Investigator Full Name or Department Name
Ex: Nina Salama, HICOR
Primary Division/Department

Basic SciencesHuman BiologyClinical ResearchPublic Health SciencesVaccine and Infectious DiseaseResearch AdministrationTranslational Science and TherapeuticsShared ResourcesClinical Care (legacy SCCA)Other
Specialization

Comp Bio/Data ScienceWet LabClinical/Patient FacingClinical Trials Management/AdminComms/Marketing/PhilanthropyOther
Please select the way(s) in which you are interested in working with SciEd.

Mentoring – guiding a student or teacher in a research/work experience for a number of weeksVolunteering – participating in a single education/outreach event

I am interested in learning more about SciEd programming for:

Explorers Virtual Internship (EVI)Coding for Cancer (CfC)Summer High School Internship Program (SHIP)Pathways Undergraduate Researchers (PUR)Summer Undergraduate Research Program (SURP)Hutch Advance-Lab Tech Career Launch (HA-LT)SeattleStatGrowsScience Education Partnership (SEP)Hutch Teacher Fellows (HTF)Murdock Partners in SciencePostbaccalaureate Scholar Program
Volunteering
Which quarter(s) are you interested in volunteering for (select all that apply)?

Autumn QuarterWinter QuarterSpring QuarterSummer Quarter
I am interested in working with (select all that apply):

Middle School and youngerHigh School studentsUndergraduate studentsTeachers
Activities I am interested in (select all that apply):

Off-campus events (Science Fair, Speaking at a school or other outside groups)Giving a scientific seminar/talkJudging research postersLeading informal discussions (Career panel, discussing career path over lunch with students)Leading students in a hands-on training lab activityVolunteering for a Science Education Summer ProgramBeing an instructor for a Science Education ProgramOther
Is there a specific Science Education program you are interested in?
Please provide any additional information or comments here.
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Should be Empty:

High School*	Undergraduate	Postbac	Teachers
Explorers Virtual Internship (EVI) Coding for Cancer (CfC) Summer High School Internship Program (SHIP)	Pathways Undergraduate Researchers (PUR) Summer Undergraduate Research Program (SURP) Hutch Advance-Lab Tech Career Launch (HA-LT) SeattleStatGrows	Postbaccalaureate Scholar Program	Science Education Partnership (SEP) Hutch Teacher Fellows (HTF) Murdock Partners in Science