Apply Bio Neuro | MentorMatch AI

Student Information

Full Name *

Pronouns *

Email *

Phone Number *

Birthdate *

Permanent Address *

City *

State *

Zip Code *

County *

Country

Demographic Information

Race/Ethnicity *

Gender Identity *

Citizenship *

Language: What is your first language? Please list if you have a second language. *

Are you a first generation college student? *

Yes

No

Academic Information

College/University *

Major *

Expected Graduation Year *

Current GPA (Minimum 3.0) *

First-Generation college student? (Means your parents did not graduate from college) *

Yes

No

Prefer not to answer

What high school did you graduate from? City/State? *

Inclusion & Accessibility

WrightChoice Mentoring thrives on creating an inclusive and welcoming atmosphere.

Do you identify with any of the following? *

ADHD

Autism Spectrum Disorder (Autism, Asperger’s Syndrome)

Deaf / Hard of Hearing (Deaf, Hard of Hearing, Hearing Loss]

Learning Disability (Dyslexia, Dyscalculia, Dysgraphia)

Mental Health (Anxiety Disorder, Depression, Bipolar Disorder, PTSD, OCD, Eating Disorders including Bulimia or Anorexia)

Mobility Impairment (Cerebral Palsy, Spinal Cord Injury, Muscular Dystrophy, Amputation, Paralysis)

Physical Health (Sickle Cell Disease, Multiple Sclerosis, Lupus, Crohn’s Disease, IBS, Epilepsy)

Visual Impairment (Low Vision, Blindness, Color Blindness, Retinitis Pigmentosa, Macular Degeneration)

I do not have a disability

Please share any accommodations that would help you fully participate *

Please indicate which technology you have access to (select all that apply). *

Computer

Wi-Fi

Phone

Virtual meeting Platform ( Zoom, Microsoft Teams, Google Meet)

Please select an option that best describes your current transportation situation. *

Personal Car

Parent Providing Transportation

Have or Need a Bus Pass

Program Logistics

Transportation *

Yes, I have a car

Yes, I use Uber or Lyft

No

T-shirt Size *

How did you hear about Bio+Neuro? *

Campus & Community Engagement

Please share your involvement in campus or community activities *

School *

Short Answer Questions

Why are you interested in the Bio+Neuro field? *

Please limit your response to 100 words or less.

0 / 600 characters

What do you hope to gain from the Bio+Neuro experience? *

Please limit your response to 100 words or less.

0 / 600 characters

Share an issue you care deeply about that affects our community *

Please limit your response to 100 words or less.

0 / 600 characters

Support & Personal Insight

What would you like your mentor to know about you? *

Share a major hurdle or challenge you've faced *

Hobbies & Interests

Please share your interests and hobbies with us:

Resume & Links

Please upload your resume *

Click to upload file

LinkedIn profile link

Social media links

Media Release Form: I, hereby grant permission to WrightChoice Mentoring (WCM) its representatives, and employees the right to take photographs, videos, and/or audio recordings of me during for promotion of organization or educational content. I authorize, WrightChoice Mentoring’s use and publish the photographs, videos, and/or audio recordings in print and/or electronically. I agree that WCM may use such photographs, videos, and/or audio recordings of me with or without my name and for any lawful purpose, including, but not limited to, publicity, illustration, advertising, and web content. I understand and agree that all photographs, videos, and/or audio recordings will become the property of WrightChoice and will not be returned. *

Yes, I agree

No, I disagree

I confirm the following *
I understand that this application is for the Bio+Neuro Program at WrightMentorMatch . This does not guarantee acceptance. Your application will be reviewed and if accepted, you will be contacted by our team.

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WrightMentorMatch

Bio+Neuro Program Application

Student Information

Demographic Information

Academic Information

Inclusion & Accessibility

Program Logistics

Campus & Community Engagement

Short Answer Questions

Support & Personal Insight

Hobbies & Interests

Resume & Links