The Health Effects Institute (HEI) is launching a new, paid summer fellowship program in the United States to support and encourage rising junior and senior undergraduate students from underrepresented backgrounds to pursue environmental health sciences. The aim of the program is to provide a research experience in the environmental health sciences to students who might not otherwise have this opportunity. We recommend that as many of the activities as possible be held in person to foster relationships between the student and the mentor, other members of the laboratory or department, and other undergraduate students who are on campus during the same period. This form collects information on potential mentors for this program to share with student applicants. Please note that the program facilitator will match students to mentors based on the interests of the students. Thus, although the time and interest of all potential mentors are valued, we will most likely not be able to match a student with every potential mentor.

Question Title

* 1. Contact Information

Information on the opportunity you could provide

Question Title

* 2. Please provide a brief description of the type of project you would expect to provide. [100 word max]

Question Title

* 3. Fellows will receive training in the following skills (select all that apply)

Question Title

* 4. Who will be the primary direct supervisor of the student? (select one)

Question Title

* 5. If you answered yes to any of the choices where you do not directly supervise, please fill out the appropriate boxes below. If not applicable, skip the question.

Question Title

* 6. How often will the student meet with their primary direct supervisor? (select one)

Question Title

* 7. Will the student be working in-person, remotely, or in a hybrid setting?

Question Title

* 8. Which meetings will be in person?

Question Title

* 9. Size of lab (short fill-in-the-blanks)

Question Title

* 10. How many other summer research students at the undergraduate level will the student regularly interact with? Opportunities include through your lab, a student desk area, or departmental events.

Information about resource availability

Question Title

* 11. Other resources available to students (Select all that apply)

Question Title

* 12. If you indicated access to trainings or seminars, please describe their frequency and duration

Question Title

* 13. Can your institution provide other financial or logistical support?

Question Title

* 14. If you indicated that your institution might be able to provide other financial or logistical support, please describe the nature of the support.

Question Title

* 15. Is there anything else you would like the applicant to know about the opportunity or resources? [100 word max]

Question Title

* 16. If matched with a fellow, do you agree to the following (must select all)?

Question Title

* 17. Do you have anything that you would like the organizers to know, or have any questions? If so, please list your questions and feedback here.

T