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STEM Mentoring Program Application

* = required field

Contact Information

1. *First Name
    *Last Name

2. Oakton ID

3. *Permanent Email

4. *Phone

5. Street Address
    Zip Code


6. *Citizenship

     U.S. Citizen
     Permanent Resident

7. My Academic Interest (Select all that apply)

     Science (biology, chemistry, physics, etc.)
     Science or Math Education

8. I am considering the following career(s)

9a. Describe why you are interested science, technology, engineering,
     or mathematics (Be specific)

    Note: This answer is limited to 200 characters. Any responses
    longer than the default will be truncated to 200 characters.

9b. Describe your STEM interest in greater detail

    Note: This answer is limited to 200 characters. Any responses longer
    than the default will be truncated to 200 characters.

10. List the science, technology, engineering, or math (STEM) courses
      you are/will be taking in Fall 2013

11. List the science, technology, engineering, or math (STEM) courses
      you took in previous semesters

12. When do you plan to transfer?

13. What do you plan to major after transferring?

Additional Information (Optional) Information you provide in this section does not influence your acceptance into the program.


     White, non-Latino
     Other, specify
     Prefer not to answer


     Prefer not to answer

Indicate my mentor preference
A mentor is assigned based on your STEM interest, but we will take your preference into account when an option is available.

Same race/ethnicity
Same gender
Same race/ethnicity & gender
Specify mentor
No Preference

At Oakton, I am a member of (Select all that apply)

     sports team(s), specify
     student organization(s), specify
     Honors Program

Currently employed? (Select all that apply)

     On Campus Part Time
     On Campus Full Time
     Off Campus Part Time
     Off Campus Full Time
     Not Employed

Final Confirmation

    By submitting this form, I will complete the following by
    December 17, 2013:

  • Enrolling in BIO200, CHM200, MAT200, PHY200, ENG200, or CSC200 as recommended by the program coordinator,
  • Participating in four activities from a Center for Promoting STEM approved list,
  • If engaging in a science, technology, engineering, or math research project, presenting project at end of semester STEM Students Symposium,
  • Passing all enrolled courses of the semester, and
  • Enrolling in at least one upper level STEM course.

Will you attend

STEM Mentoring Program Meeting on Wed., August 28, 2013 from 3:00 to 4:00pm.
STEM Students Symposium on Tue., Dec. 3 or Wed., December 4, 2013 at 3pm.


Furthermore, I give Oakton Community College permission to use my biographical information, my essay, and/or photograph in promotional materials, media releases, and other College publications.

Please contact Gloria Liu (847.635.1738, if you have any questions.

Contact STEM

Joe Kotowski
Director, Center for Promoting STEM
Professor, Mechanical Design & Mathematics
Room B231, Skokie

Gloria Liu
Coordinator & Co-Director, Center for Promoting STEM
Room 2166, Des Plaines

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