PATHS Interviewee Nomination

Do you know an LGBTQ+ STEAM professional or student with an inspiring story? Are you involved in STEAM and interested in sharing your story? Let us know! We are looking for a diverse range of interviewees within the LGBTQ+ STEAM community for season 6 of PATHS. Please fill out the information below, and provide some details about your background. We look forward to connecting with you!

Nominee Contact Information

Nominee Contact Information

I am nominating: *

Myself

Someone else

Nominee name *

Pronouns

How do you identify within the LGBTQIA+ community? *

Do you identify as trans? *

Yes

No

Prefer not to disclose

Is there any other part of the nominee's identity that is important to include?

Nominee's Email Address *

Nominee's Phone Number

Nominee's LinkedIn

Where is the nominee located? (Please include City and State) *

If nominating someone else, what is your name and relationship to the nominee? *

Nominee STEAM Background

What area of STEAM is the nominee involved in? (Science, Technology, Engineering, Arts, Mathematics) *

Please specify the field the nominee is in *

What types of STEAM education the nominee has received? Select all that apply *

Please Specify *

Can you provide more information about your background in STEAM? *

Nominee PATHS Information

Please provide why the nominee would be interested in participating in a PATHS Interview? *

Is the nominee interested in participating in our PATHS Mentorship Program? *

Yes, as a Mentor

Yes, as a Mentee

Maybe

No

Please provide us with any other information you feel is relevant