The Alliance for Access to Science, Technology, Engineering, and Mathematics

Mentor Application

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Shape the future...

be a DO-IT Mentor.

The DO-IT (Disabilities, Opportunities, Internetworking, and Technology) electronic mentoring community provides an opportunity for students with disabilities to communicate via electronic mail and during program activities with mentors and other students with disabilities. Your role as a DO-IT Mentor is a mix of friend and teacher. Your goal is to inspire and facilitate personal, academic, and career achievements in the DO-IT participants for whom you mentor. These protégés are college-capable students with disabilities pursuing challenging academic and career fields.

Do you have what it takes to be a DO-IT Mentor?

The relationships you develop with your protégés become channels for the passage of information, advice, challenges, opportunities, and support. DO-IT Mentors offer protégés:

• Information
  Mentors share their knowledge, experiences, and wisdom.
• Contacts
  Mentors provide valuable opportunities by facilitating academic, career, and personal contacts.
• Challenges
  Mentors stimulate curiosity and build confidence by presenting new ideas, opportunities, and challenges.
• Support
  Mentors encourage growth and achievement by providing an open and supportive environment.
• Goal Setting
  Mentors help protégés discover talents and interests and define and attain their goals.
• Advice
  Mentors guide protégés in reaching academic, career, and personal goals.
• Role Models
  By sharing stories of achievement with protégés, mentors can become role models.

Who are DO-IT Mentors?

DO-IT Mentors are college students, postsecondary faculty, and professionals in a variety of challenging academic and career fields. Many of the mentors have disabilities themselves. The mentors support high school and college students with disabilities as they transition to college and careers.

How do DO-IT Mentors and protégés communicate?

Mentors and protégés communicate primarily through the use of electronic mail. Email eliminates the challenges imposed by time, distance, and disability that are characteristic of in-person mentoring. Frequent email communication combined with personal contact at DO-IT sponsored events, facilitates personal, academic, and career achievement.

DO-IT Mentors are subscribed to several electronic discussion lists. These lists include:

• doitsem - A public forum to discuss STEM issues pertaining to individuals with disabilities.
• doitchat - A forum where DO-IT protégés and mentors interact.
• mentors - A discussion list for mentors.
• disability-specific lists - Where mentors and protégés each participate in special interest groups to discuss issues related to a specific disability area.

For more information about DO-IT's mentoring community, consult Opening Doors: Mentoring on the Internet at http://www.washington.edu/doit/Brochures/Technology/doors.html

AccessSTEM Mentoring Teams

As part of a special project, DO-IT is inviting Mentors with academic and/or professional backgrounds in science, technology, engineering, and mathematics (STEM) fields to participate in AccessSTEM mentoring teams. This effort is part of DO-IT's Northwest Alliance for Access to Science, Technology, Engineering, and Mathematics, which is funded by the National Science Foundation (Cooperative Agreement #0227995). Each mentoring team links students together with Mentors who are studying, teaching, and working in a STEM area similar to those the protégé is interested in pursuing. Ideally, each AccessSTEM mentoring team is composed of at least one high school student, one college student, and one STEM professional. These Mentors participate on the AccessSTEM, mentors, and doitsem discussion lists; they have the option of joining doitchat and disability-specific lists.

Applying to become a Mentor

As a DO-IT Mentor, you must have access to email and the Internet. To apply to be a DO-IT Mentor, complete the attached application.

Because safety is of particular concern for young people using the Internet, this position requires completion of a criminal history background check. All Mentor candidates are asked to complete and return the University of Washington Conviction/Criminal History Information form. This form will be mailed to you once we receive your completed application.

DO-IT Mentor Application Form

Complete the form below, attaching additional pages if necessary.

_____________________________________________
Name


_____________________________________________
Mailing Address


__________________ 
City 


_________ 
State


_________
Zipcode


__________________  
Home Phone


__________________ 
Email 


1. Are you currently a college student? If yes, 
what institution do you attend? What is your 
year in school and field(s) of study?




2. What is your occupation? Are you currently 
employed? If so, who is your employer? 
What is your position?




3. Please list any postsecondary degrees 
you have completed.





4. Have you ever been a mentor before?  
If so, please describe your experience(s).





5. Have you had personal or professional 
experiences with disabilities that you could 
share with DO-IT participants? If yes, please 
describe.




6. Please indicate any special interest or 
background in science, technology, 
engineering, and/or mathematics. Are you 
interested in joining an AccessSTEM Team?




7. Do you have any hobbies or special skills 
that you think will benefit DO-IT mentees?




8. Do you speak a language other than English? 
If yes, please list.




9. Mentoring a young person is a big 
responsibility and can change the lives 
of both the mentor and the mentee. What do 
you hope to gain from the experience? 
What do you hope the mentee will gain?

References: Please list the names and contact information for three references.

1. ___________________________________________



2. ___________________________________________



3. ___________________________________________

Please note that, on occasion, DO-IT Mentors are featured in DO-IT printed and web-based materials such as DO-IT News and in other publications. As a DO-IT Mentor, you agree to allow DO-IT and DO-IT project partners to publish information including, but not limited to, your first and last name, email address, city and state of residence, name of school, employer, disability, age, and interests. This information is used for program reporting and data analysis. As a DO-IT Mentor, you also waive any right to inspect or approve the finished publication or the eventual use for which it might be applied.

Use of Photographs and Videos:

Many DO-IT events, such as the yearly mentoring luncheon, are photographed and/or videotaped. If you choose to attend any of these events, you may be photographed and/or videotaped. Please check below if you do not give DO-IT and DO-IT project partners permission to copyright, distribute, sell, broadcast, duplicate, exhibit and/or use film, audiotape, photographs, printed information, and/or drawings of yourself without limitation for general education, information dissemination, and research purposes in videos, audiotapes, and printed publications, and on the World Wide Web. In addition, you waive any right to inspect or approve the finished publication or other product in which your image/information might be used. Check here if you do not give permission to be included in pictures or videos.

I have read and agree to the expectations listed for DO-IT mentors, publication guidelines, and the Use of Photographs and Videotape guidelines as indicated above. I agree to report to any past convictions. I authorize DO-IT to contact my references and process a background check. I will inform DO-IT of any convictions or charges that relate to minors or vulnerable adults.

______________________________________________    
Signature                               Date

Please return this completed application DO-IT by mail or fax to:
DO-IT
University of Washington
Box 355670
Seattle, WA 98195-5670
FAX: 206-221-4171

If you have any questions about DO-IT Mentors or this application, please contact DO-IT at:

Copyright © 2002 - 2008 by DO-IT, University of Washington. Permission is granted to copy these materials for educational, noncommercial purposes provided the source is acknowledged.