DO-IT Mentors Application

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 email 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.

How do DO-IT Mentors and protégés communicate?

Mentors and protégés communicate primarily through the use of email, eliminating 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.uw.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 Alliance for Students with Disabilities in Science, Technology, Engineering, and Mathematics, which is funded by the National Science Foundation (Award #HRD-0227995 and HRD-0833504). 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.

Eligibility

College students, postsecondary faculty, and professionals from a variety of challenging academic and career fields are encouraged to apply.

How to Apply

Submit the DO-IT Mentor Application online at www.uw.edu/doit/Stem/mentor_app.html or submit the following form by postal mail, fax, or email.

Because safety is of particular concern for young people using the Internet, all Mentor candidates are asked to complete and return the University of Washington Conviction/Criminal History Information Questionnaire. We will email you a link to this form when we receive your completed application.

DO-IT Mentor Application Form

Complete the form below, attaching additional pages if necessary.

_____________________________________________
Name


____________________________________________
Position


_____________________________________________
Organization


_____________________________________________
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. Are you currently employed? If so, who is your employer?




3. Please list any postsecondary degrees 
you have completed.





4. Have you ever been a mentor?  
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. ___________________________________________

Participation Agreement

I have read and agree to the expectations listed for DO-IT Mentors. I authorize DO-IT to contact my references and process a background check. I agree to report any past convictions to DO-IT at the time of application. Further, I agree to report to DO-IT any future charge or conviction at the time it occurs. I will inform DO-IT of any convictions or charges that relate to minors or vulnerable adults.


______________________________________________ Signature Date

Audio/Visual Release Agreement

I hereby agree to participate in the creation of media materials by DO-IT (Disabilities, Opportunities, Internetworking, and Technology) and by DO-IT project partners. I understand that various materials may be created from or associated with my participation in DO-IT events or programs, including the following (Media Materials):

  • Audio and/or video recordings with text transcripts or summaries
  • Photographs, including photographs of me
  • Biographical information about me including name, disability, age, interests, city and state of residence, and name of school.

To the extent I may own rights in the Media Materials, I hereby give permission in perpetuity and irrevocably to DO-IT to include the Media Materials in digital, print, or other projects (“Projects”). I understand and agree that including the Media Materials in the Projects means that they may be copied, distributed, displayed, and performed in various media, now known or later developed, including without limitation websites, print media, and exhibits. Except for the permission I am granting here, I retain ownership and all rights I may have in the Media Materials. I understand and agree that I will receive no monetary payment for the permission I am granting in this Agreement. This Agreement expresses the complete understanding of the parties.


______________________________________________ Signature Date

Please return this completed application DO-IT by mail or fax to:
DO-IT
University of Washington
Box 354842
Seattle, WA 98195-4842
FAX: 206-221-4171


If you have any questions about DO-IT Mentors or this application, please contact DO-IT at:
   206-685-DOIT (3648) — voice/TTY
   888-972-DOIT (3648) — toll free voice/TTY
   206-221-4171 — FAX
   509-328-9331 — voice/TTY, Spokane
   doit@uw.edu