Become a Mentee Form

Mentee Registration Form

First Name

Last name

Preferred Name

Pronouns

She/Her

He/Him

They/Them

Otro

Date of Birth

Month

Day

Year

Age

School Name

Student Email

Student Phone Number with Country Code

Country

US State

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship to Student

Parent/Guardian Email

Parent/Guardian Phone Number

Chapter Information

Chapter

Diversity & Demographics

Do you identify as Hispanic or Latino?

Yes

No

Do you intend to be a first-generation college student (meaning neither parent or guardian earned a four-year bachelor's degree)?

Yes

No

Unsure

Prefer not to answer

Research Interests

What do you hope to gain from participating?

Have you previously participated in EnvironMentors?

Yes

No

Media & Permissions

Photo/Video Release

Yes

No

Program Agreement

I understand the expectations of participating in EnvironMentors.

Mentee Agreement

I understand that by participating in EnvironMentors, I am expected to actively participate in the program, communicate with my mentor, and complete my research project.

I agree to:

I understand and agree to the EnvironMentors mentee expectations and program policies

Photo & Video Consent

I give GCSE permission to photograph and/or record me during EnvironMentors and GCSE events and activities and to use these materials for program communications, websites, social media, reports, and promotional purposes.

GCSE Newsletter

I would like to receive the GCSE newsletter and occasional updates about GCSE programs, events, and opportunities.

Would you like to become a GCSE member?

As an EnvironMentors participant, you will receive free GCSE membership once the EnvironMentors program begins.

GCSE membership gives you access to the broader GCSE community, programs, events, resources, and opportunities throughout the program year. *Membership is completely free for EnvironMentors participants.

Opción única

Yes

No

Mentee Name

Date

Month

Day

Year

Parent/Guardian Name / Required for mentees under 18

I give permission for my child to participate in EnvironMentors and agree to the expectations outlined above. — Required for mentees under 18

Are you a scientist or educator?