Roots to Wings 2024-2025 Student Application

Roots to Wings (RTW) is a transformative co-mentoring pathway program focused on creating avenues for Indigenous and Latinx learners to enter the STEM and healthcare professions. It involves a collaboration between and among PNWU, the Yakama Nation, Heritage University, Mount Adams School District, and joining us this year, Toppenish School District, Wapato School District, Yakima School District, and Grandview School District. The program pairs Health Professional Students with aspiring young scholars between 6th and 12th grade attending school districts on the Homelands of the Yakama Nation, Yakima Valley and other Indigenous communities in the state of Washington. For further information, we recommend viewing the TEDx Yakima presentation of RTW by Dr. Ramos-Diaz. Thank you for your interest in the Roots to Wings Transformative Co-mentoring Program. Tentative Dates for 2024 - 2025: November, January, February, March, and April dates are TBD. Sessions are bi-monthly except for December. The last session will be the graduation ceremony in late April. If you have any further questions on the time commitment or the program in general please feel free to contact rootstowings@pnwu.edu

Name*

First NameLast Name

School you are attending*

Grade*

Age*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Student's Email*

example@example.com

Lab Coat Size *Coats are listed in adult sizing. *

Will you be participating in any other extracurricular activities? If so, what and when do they happen?*

Have you participated in the Roots to Wings program before?*

If you have participated in Roots to Wings, which year(s)? *

Essay Questions
Please answer the following questions to the best of your ability.

Why are you interested in the Roots to Wings program?*

What do you hope to learn or gain from the Roots to Wings program?*

Are you interested in the health sciences or STEM? If so, which professions?*

Why should we choose you for the mentoring program?*

Please share any additional comments or information you would like to share with us.*

Parent/Legal Guardian Name*

Parent/Legal Guardian Phone Number*

Please enter a valid phone number.

Parent/Legal Guardian Email *

Consent*

I understand the commitment my child is making and my commitment to ensure my child’s participation. I understand it is my responsibility to ensure my son/daughter attends school and the program. On the days of the program I understand it is my responsibility to ensure my child is picked up at the designated spot and time after program. In addition, I give permission for my son or daughter to be photographed or videoed during Roots to Wings (RTW) activities for educational purposes. With this agreement, I give permission for my child to apply to Roots to Wings 2023-20234.

Photography Consent*

I am granting permission for my child/minor to be photographed. I understand that all photographs submitted become the property of Pacific Northwest University of Health Sciences. I also agree that the photographs may be published in educational books (including electronic versions), supplemental products, and related advertising material, and I understand that there will be no compensation.

Parent/Legal Guardian Signature*