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
Optional: Please specify 'other' here.
Email*
example@example.com
Position*

Graduate studentPost-doc/Research AssociateStaff ScientistNon-scientific StaffScientific StaffFaculty/PIClinical Staff/FacultyOther
If you selected 'Other', please specify here.
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 Certificate
What is your primary worksite?*

Fred Hutchinson Cancer CenterUniversity of WashingtonSeattle Children's HospitalShoreline Community CollegeOther
If you selected 'Other', please specify here.*
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
If you selected 'Other', please specify here*
Specialization*

Comp Bio/Data ScienceWet LabClinical/Patient FacingClinical Trials Management/AdminComms/Marketing/Philanthropy
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 Program
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