Rural Outreach & Mentorship Initiative: Mentee Sign-Up (2020-2021)
Hi! Thank you so much for your interest in the Rural Outreach and Mentorship Initiative (ROMI). We are a diverse team of medical students from all around Canada who have come together with a single purpose: to support youth living in rural and remote communities!

Currently, ROMI is offering free one-on-one mentorship for high school students from rural communities interested in exploring a career in medicine. Of note, all contact information and names in this form will not be shared with anyone outside of the program. Please do not sign up for this program if you are from a large urban center like Toronto or Calgary for example.

To be matched with a mentor, please fill out and submit the questions below:
Sign in to Google to save your progress. Learn more
Email *
What is your name? *
Preferred language?
Clear selection
Where are you from? (Town, Province/Territory) *
What Year of High school are you in? *
Do you have access to a computer/phone/internet? *
In addition to 1-on-1 meetings with your medical student mentor, we will be organizing panel discussions and group sessions. What are you most interested in learning about?
To help us make the best possible match, tell us about your hobbies/interests: *
If you are interested in being paired with a mentor who identifies as LGBTQ+, indigenous, or male/female, please let us know here:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy