SEP Mentor Sign Up

Form type

_signUp

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 *

Gender:

Female Male Non-binary Prefer something else Prefer not to answer

How do you self-identify your gender? Please include pronouns. (Optional)

Ethnicity:

Hispanic or Latinx Not Hispanic or Latinx Prefer 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 America Asian Black/African Native Hawaiian/ Pacific Islander White Prefer not to answer

How do you self identify your race, ethnicity, and/or geographic heritage? (Optional)

Position *

Graduate student Post-doc Non-scientific Staff Scientific Staff PI

Highest Degree Completed

BA/AB/BS MA/MS/MPH PhD/MD

Are you a current student of the UW/Fred Hutch Molecular and Cellular Biology (MCB) Program participating in the Science Education TAship? *

Yes No

Did you have an SEP teacher when you were in middle or high school? *

Yes No Not 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? *

Yes No Not 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? *

1 2

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. *

SEP Mentor Sign Up

Demographic Information