PROPEL NW Mentor Application Form

PROPEL NW Mentor Application Form

Thank you for your interest in mentoring for PROPEL Northwest. This form will collect your contact information, research interests, and affiliations. Please contact Alison Stanbery @ itipb@uw.edu with any questions about this application.

Name(Required)
Scholar's Name(Required)
MM slash DD slash YYYY
I am aware that my scholar will need to attend in-person activities at least 1x/month for 1-3hrs in South Lake Union or on UW main campus. I agree to support my scholar in attending these activities (including transit time).
Please select the research category you are in (you can select multiple).(Required)
Please select your academic rank:(Required)
Max. file size: 50 MB.

The following questions are optional and help us analyze our mentor demographics.

Do you identify as transgender?
Do you identify with any of the following racial or ethnic groups? Select all that apply.
Are you from an economically or educationally disadvantaged background?
Are you living with a disability?
Do you belong to the first generation in your family to be born and/or raised in the United States?
Do you belong to the first generation in your family to attend college?