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AccessSTEM Team Application

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Are you a high school or college student with a disability?

Would you like to gain valuable experience through paid internships and other work-related opportunities?

Are you interested in the fields of science, technology, engineering, or mathematics?

Would you like to communicate with mentors working in these fields?

If so, then apply now to become a member of our AccessSTEM Team!

DO-IT (Disabilities, Opportunities, Internetworking, and Technology) at the University of Washington supports college-capable students with disabilities as they pursue challenging academic programs and careers. DO-IT's Northwest Alliance for Access to Science, Technology, Engineering, and Mathematics (AccessSTEM) is a five-year project funded by the National Science Foundation (Cooperative Agreement #0227995). The purpose of the project is to increase the number of people with disabilities in science, technology, engineering, and mathematics (STEM) careers by encouraging and supporting students with disabilities who show interest and aptitude in STEM. These students become part of the AccessSTEM Team, engaging in an on-line community of peers and professionals, paid internships, other work experiences, research opportunities, and other activities as they transition to college, graduate school, and employment.

We are recruiting high school and college students with disabilities in Washington, Oregon, Idaho, and Alaska to join the AccessSTEM Team. As an AccessSTEM Team member, you will engage in experiences that will enhance your college and career success.

AccessSTEM Team Eligibility

High school or college students with disabilities in Washington, Oregon, Idaho, or Alaska are eligible to be AccessSTEM Team members. Priority is given to students who demonstrate an interest and aptitude in pursuing professional careers in science, technology, engineering, or mathematics fields. AccessSTEM Team members must have an email account and access to the Internet.

Participation Agreement

As a member of the AccessSTEM Team, you must actively communicate with AccessSTEM staff, peers, and mentors. To remain on the AccessSTEM Team and to be eligible for work-related opportunities, such as internships, you must be an "active participant." As an "active participant," you are expected to:

  1. Log on to your email account at least once per week and read and respond to electronic mail messages.
  2. Regularly communicate with your AccessSTEM mentoring group.
  3. Attend AccessSTEM events when possible.
  4. Notify AccessSTEM staff of any changes in your contact information, or your ability to participate in AccessSTEM internships and activities.

Application Requirements

Please contact DO-IT if you would like assistance in completing any portion of your application.

  1. APPLICATION FORM
    Complete the attached two-page AccessSTEM Team application form. This form must include a parent or guardian signature if you are under 18 years of age.
  2. ESSAY
    Submit a one-page essay with your application explaining why you are interested in participating in an AccessSTEM internship and mentoring and how participation will help you reach your career goals. Include school honors, extracurricular and community activities, work-related experiences, and any other relevant information about yourself.
  3. LETTERS OF RECOMMENDATION
    Submit one letter of recommendation from a teacher, faculty member or someone who has worked with you closely.
  4. RESUME
    Submit an up-to-date copy of your resume.

Submitting AccessSTEM Team Applications

Applications are accepted on an ongoing basis. The AccessSTEM Team application packet may be submitted via postal mail or FAX to the address below.

AccessSTEM Team Application Form

STUDENT DATA


Date: _____________


First Name: _______________________ 


Last Name: ________________________


Address:___________________________


City: _____________________________ 


State: _______ 


Zip: _________


Telephone: (____)___________________ 


Email Address: _________________________


Name and Address of Parent/Guardian: 
(if under 18)

______________________________________________


______________________________________________


Gender: ___________


Date of Birth: ___________


Ethnic Background (optional):_________________    


Please State Your Disability: 

__________________________________________


Describe any accommodations that you may need to 
participate in an internship:

______________________________________________

ACADEMIC BACKGROUND

Currently enrolled in:

____High School 

____Community College 

____Four-Year University/College


School Name: _________________________________ 


Anticipated Graduation Date: _________________


City/State: __________________________________


Major(s) (if applicable): ____________________

EMPLOYMENT/INTERNSHIP INFORMATION


U.S. Citizen? ____Yes ____No 


If NO, do you have a right-to-work permit? 
____Yes ____No


Where are you able to work in an internship 
of other work-related experience?

Cities:_______________________________________    


Counties:_____________________________________
Publication Guidelines

Please note that, on occasion, AccessSTEM Team members are featured in DO-IT printed and Web-based materials such as DO-IT News and in other publications. As an AccessSTEM Team member, 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 an AccessSTEM Team member, you also waive any right to inspect or approve the finished publication or the eventual use for which it might be applied. Although we will work with AccessSTEM members to plan and initiate disclosure of their disabilities to potential employers or schools, through the above mentioned publications and in conjunction with AccessSTEM activities, your disability may be disclosed or implied.

Use of Photographs and Videotape:

Some AccessSTEM events and work-related experiences are photographed and/or videotaped. When you participate in these activities you may be photographed and/or videotaped. As an AccessSTEM Team member, you agree to 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 in the Participation Agreement, Publication guidelines, and the Use of Photographs and Videotape guidelines as indicated above.



______________________________________________    
Signature of applicant



______________________________________________
Printed Name of applicant
For Applicants Under the Age of 18 Years

I give permission for my son/daughter to participate in AccessSTEM activities and events. I have read and agree to the above conditions, including the Participation Agreement expectations, Publication guidelines, and the Use of Photographs and Video guidelines as indicated above.



_____________________________________________      
Signature of Parent/Guardian 



_____________________________________________
Printed Name of Parent/Guardian

If you have questions about AccessSTEM 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
doit@u.washington.edu.

Mail your completed application to

DO-IT
University of Washington
Box 355670
Seattle, WA 98195-5670