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*
Fred Hutchinson Cancer Center, University of Washington, Seattle Children's Hospital, Shoreline Community College
Lab Principal Investigator or Director*
Ex: Nina Salama, HICOR
Work Address
Street Address
Lab Room Number and/or Mailstop
Street Address Line 2
City
State
Zipcode
Primary Contact Email*
Primary Contact Phone*
Graduate studentPost-doc/Research AssociateStaff ScientistNon-scientific StaffScientific StaffFaculty/PIClinical Staff/FacultyOther
If you selected 'Other' for Position, please specify here:
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
YesNo
YesNoNot sure
If you answered Yes above, please share the teacher's name.
If you answered Yes above, please share the school.
YesNoNot Sure (please explain)
If you answered Not Sure above, please explain below.
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.*
Yes - I expect to be doing dry lab work this summerNo - I predominantly do wet lab workI don't know
XXXLXXLXLLMSXS
VegetarianVeganGluten FreeDairy FreeNut freeHalalKosherOther
YesNo
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