Roots to Wings 2024-2025 Student Application

Roots to Wings 2025-2026 Student Application
Program Description: 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, Toppenish School District, Wapato School District, Grandview School District, East Valley School District and the Yakima 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 2025 - 2026: October, November, January, February, March, April, and May dates are TBD. Sessions are bi-monthly except for December. The last session will be the graduation ceremony in either late April or early May 2025. If you have any further questions on the time commitment or the program in general please feel free to contact RTW Program Coordinator Debbie Helgert at dhelgert@pnwu.edu
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Name

First NameLast Name
Age
School you are currently attending
Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Phone Number
Student's Email
example@example.com
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 so, which years?
Coat size

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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 Root to Wings program?
Please share any additional comments or information you would like to share with us.
Parent/Legal Guardian Information
Parent/Legal Guardian Name

First NameLast Name
Parent/Legal Guardian Phone Number
Parent/Legal Guardian Email
example@example.com
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 participating in clinical skills training activities that may involve appropriate physical contact in a supervised medical context(e.g. taking vital signs, practicing reflex exams, glucose checks involving finger sticks). With this agreement, I give permission for my child to apply to Roots to Wings 2025-2026.This box is to be checked by a parent or guardian who wishes to opt their child out of participating in clinical skills training activities that may involve appropriate physical contact in a supervised medical context. These activities are part of the educational program and are conducted in a professional and respectful environment. By signing this form, I acknowledge that I am choosing to exclude my child from participating in clinical skills training activities involving physical contact (e.g. taking vital signs, practicing reflex exams, glucose checks involving finger sticks). I understand that alternative learning opportunities may be provided where possible
Photography Consent*

I am granting permission for my child/minor to be photographed or videoed. I understand that all photographs/videos 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.
By typing my name below, I acknowldege that I have read and give my consent for the statements above.
Parent/Legal Guardian Name*
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Roots to Wings 2025-2026 Student Application

Essay Questions

Parent/Legal Guardian Information