UW LEND Trainee Registration

Section 1: About You

1. First Name (Legal Name) *

2. Middle Name (Legal Name)

3. Last Name (Legal Name) *

4. Preferred Name (optional — name you go by if different from legal name)

5. Date of Birth *

6. Birth Place: City *

7. Birth Place: State / ProvinceSelect N/A if your birth country does not have states or provinces.

8. Birth Place: Country *

9. Do you have a UW NetID? * Yes No

Example: if your UW email is abc@uw.edu then abc is your UW NetID. Your UW NetID is not your student ID or Employee ID.

12. Are you a U.S. citizen or permanent resident (green card holder)? * Yes No

UW LEND can only offer training stipends to individuals who are U.S. citizens or permanent residents. We welcome all applicants; citizenship status only affects eligibility for a stipend.

Section 2: Contact & Background

13. Current Mailing Address: Street *

14. City

15. State / Province *Select N/A if your country does not use states or provinces.

16. ZIP / Postal Code

17. Is your permanent address the same as your mailing address? * Yes No

18. Primary Email *

19. Secondary Email

20. Phone * Format: ###-###-#### (e.g. 206-555-1234). Digits will be formatted automatically as you type.

21. At the time of admission to the LEND program, where are you working or spending a majority of your time? *

22. Based on your setting in the previous question, what is your title or role at the time of admission to the LEND program? *

UW LEND Trainee Registration

Section 1: About You

Section 2: Contact & Background

Permanent Address

Section 3: Academic & Demographics