STEMpowerment Mentee Application
Welcome and thanks for your interest in the STEMpowerment Mentorship Program! If you have any questions about the application or the program in general, please email
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number (Optional)
Your answer
Current Grade *
Are you currently or have you previously been home-schooled? (Optional)
Name of current educational institution *
Your answer
Which languages do you speak fluently?
Your answer
Do you identify with any of the following groups? (Check all that apply) *
Which field within STEM are you most interested in? *
What do you hope to gain from this program? (100 words max) *
Your answer
Is there anything else you would like us to know about you? (Optional)
Your answer
This is the end of the application
Thanks for applying, we will get back to you within 5 working days.
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