Form SLAC Mentor Application Last Name* First Name* Please list your email address* Your Division/Academic Program (e.g., PSYCH: BNS, PSYCH: DEV, PSYCH: L&C, LING, SLHS, ESPY, GGS, etc.)* If you are submitting an application in conjunction with a graduate student (to support a student who is seeking funding) please list their name below. Letter of Recommendation*Letters should include: -How this student will benefit from SLAC -What qualifies this student for SLAC support -How this student compares to other students in SLAC or home PhD program -Any other details / concerns (e.g., if SLAC funding is expected to influence admission decisions)If you prefer to upload a recommendation letter here you can do so in lieu of completing the above boxMax. file size: 100 MB.Please tell the committee why you would like to serve as a SLAC mentor. What can you contribute to the program? (in no more than 500 words) For details about the full scope of the program, please refer to the grant proposal below.* Grant ProposalSLAC mentors are expected to be available to serve as a breadth mentor to a student from a different program of study. Please indicate your willingness to be a breadth mentor by listing your area(s) of study. This information will enable us to match students with breadth mentors. SLAC mentors commit to serving on at least one committee. Please indicate which committees you would be willing to serve on.*(Multiselect by holding control or command key while making all selections).DiversityEventsCurriculumOutreachSpeaker SeriesOtherPlease indicate what "other" committee option you suggest. SLAC mentors are expected to attend the weekly SLAC brownbag as much as possible. I would be happy to attend the brownbag, assuming the time is compatible with my schedule. I am not available to attend another brownbag. We appreciate the individual strengths that faculty participants can bring to the SLAC program. Of the following items, which would you be willing to volunteer for? (Indicating your willingness here is not a hard commitment, but will allow us to capitalize on the strengths of our faculty.)*(Multiselect by holding control or command key while making all selections).Lead a session (one class period) in the professional development seminar--indicate a possible topic or topics below.Guest lecture in the SLAC Seminar (on learning or communication)Co-Teach Outreach Course (1 credit)Help organize J-term (our January session tutorials and workshops)Lead a research challenge teamOpen your lab meeting / research meeting to SLAC students and facultyOtherPlease indicate the "other" item you would be willing to volunteer for. Trainee FundingPlease indicate what the funding plan is for the student after the SLAC fellowship-we require a letter from your department stating the level of support the students will receive after SLAC fellowship.Additional comments for the review panelFileMax. file size: 100 MB.CommentsThis field is for validation purposes and should be left unchanged.