NBTS Mentor Interest Form

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* 1. Full Name

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* 2. Email

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* 3. Phone

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* 4. How would you describe your own ethnicity?

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* 5. Affiliation:

Oregon State University

Non-profit

Tribe

Industry

Community College

Individual

Other and or description:

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* 6. Professional title

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* 7. What is your field of expertise or type of natural science background?

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* 8. Do you have mentoring experience?

Yes

If yes, please describe:

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* 9. Do you have experience mentoring multicultural students?

Yes

If yes, please describe:

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* 10. What type of mentoring would you say is your strongest?

Academic

Personal development / socio-emotional

Career exploration and development

Other (please specify)

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* 11. Do you have experience working with Native American students or communities?

Yes

If yes, please describe:

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* 12. Are you willing and available to mentor an undergrad student periodically? Time commitment is approximately, or averaging, 30 minutes per week per student.

Yes

Maybe

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* 13. Mentoring may occur over virtual formats (i.e. zoom) or telephone, or in person. Would you consider mentoring an NBTS student intern enrolled at:

Oregon State University (undergrad student in summer internship)

Southwestern Oregon Community College (internships occur year-round)

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* 14. Do you also have internship opportunities to offer?

Yes

If yes, please briefly describe or insert a link to more info.: