UBC Women in Science: Student Application Form 2016-2017
This application form is for students who are interested in being a part of the UBC Women in Science Mentorship Program for one term during the 2016-2017 academic year. Please fill out this application form with as much detail as possible.

Applications with limited information will not be matched with a mentor. Filling out this application does not guarantee that you will be matched with a mentor. The deadline to submit the form is Sunday, October 16, 2016 at 11:59 PM. Thank you!

First name
Your answer
Last name
Your answer
Age
Your answer
Email address
Please list the email address that you would prefer correspondence with a mentor.
Your answer
Phone number
Please list the phone number that you would prefer correspondence with a mentor.
Your answer
Have you paid for club membership for the 2016-17 year? The WiS Mentorship Program requires our mentees to be members of our club.
The membership fee is $6 (it is $5 if you like our Facebook page). Check out the UBC WiS Facebook page: https://www.facebook.com/ubcwomeninscience/
Do you have any previous mentoring experience? If yes, please briefly describe.
Your answer
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