Mentor Sign Up for BioBuilderClub

Prefix

First Name *

Last Name *

I am a (select all that apply) *

Student
Parent
Teacher / Educator
School Administrator
Industry Professional
Scientist / Engineer
Program Manager / Admin
Community Member
Media Contact
Other

Gender Identity *

Female
Male
Not listed here
Prefer not to say

Preferred Pronouns

Race *

American Indian or Alaska Native
Asian (origins in the Far East, Southeast Asia, or Indian subcontinent)
Asian (South Asian, Asian American, Pacific Islander)
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander (origins in Hawaii, Guam, Samoa, or other Pacific Islands)
White (origins in Europe, the Middle East, or North Africa)
Two or more races
Other
Prefer not to say

Birth Date

// (mm/dd/yyyy)

Email *

Address *

City *

State *

Province (Foreign)

Zip (enter 00000 if not applicable) *

Country *

Phone *

Full Organization or School Name *

Job Title / Role *

Please indicate your area(s) of expertise: *

Environment
Food
Fuel
Health
Medicine
Manufacturing
Not listed here

Are you available 2 hours per month, from October through March, to serve as a volunteer mentor, supporting an assigned BioBuilderClub team by phone, email, or Zoom/Google Meets/etc.? *

Yes
No

Are you willing to be assigned to more than 1 team? (2 teams = time commitment of 4 hours per month) *

Yes
No

Please describe your background in science, including educational focus, areas of interest/research, industry experience, etc. *

Please share why you are interested to serve as a mentor, and what it means to you to participate. *

Please list any specific things for us to keep in mind as we match you with a team. (i.e. scheduling conflicts, timezone). *

How did you learn about this mentoring opportunity with BioBuilderClub? *

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Mentor Sign Up for BioBuilderClub