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*
Lab Principal Investigator or Director*
Work Address*
Street Address
Lab Room Number and/or Mailstop*
Street Address Line 2
City*
State*
Zipcode*
Primary Contact Email*
Primary Contact Phone*
Demographic Information
Gender:*

FemaleMaleNon-binaryPrefer something elsePrefer not to answer
How do you self-identify your gender? Please include pronouns. (Optional)
Ethnicity:*

Hispanic or LatinxNot Hispanic or LatinxPrefer not to answer
Please select the category or categories that you identify with. Please select all that apply.*

American Indian/Alaskan Native or Indigenous People of North AmericaAsianBlack/AfricanNative Hawaiian/ Pacific IslanderWhitePrefer not to answer
How do you self identify your race, ethnicity, and/or geographic heritage? (Optional)
Position*

Graduate studentPost-docNon-scientific StaffScientific StaffPIOther
Highest Degree Completed*

BA/AB/BSMA/MS/MPHPhD/MDPrefer not to answerOther
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
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SEP Mentor Sign Up

Demographic Information