UW School of Medicine Pre-Med Mentorship Program: Survey for Pre-Medical Students

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Please fill out this form so we can help place you with a mentor who can provide the best guidance for your needs.

Email *

What is your first and last name? *

What school do you currently attend? If your school has multiple campuses, please include which campus you attend. *

What year in school are you? *

Freshman

Sophomore

Junior

Senior

Post-Bac

Other:

What is/was your major? *

Do you have access to a pre-med or pre-health advisor at your school? *

Yes

Do you identify as belonging to a group that is underrepresented in medicine? *

Yes

If you are comfortable sharing, please expand on your answer to the question above. Survey responses are reviewed and managed by those who coordinate the mentorship program and are otherwise kept confidential.

How familiar are you with the requirements for medical school? *

I am very familiar with the application process.

I have a general idea of what is required to apply, but I haven't looked into the requirements in detail.

I am somewhat familiar, but I still have a lot of questions.

I am interested in applying to medical school, but am not at all familiar with the application process.

Other:

Which of the following do you need the most help with? What would you like to focus on? Choose all that apply. *

Coursework (deciding what classes to take, picking a major, etc.)

Deciding on a career in healthcare

Finding extracurricular activities

Research opportunities

Volunteering

Shadowing

MCAT advice

Developing a personal statement

Editing a personal statement and/or application essays

AMCAS or AACOMAS

Deciding what schools to apply to

Interview tips

Pursuing opportunities during your gap year

Connecting with other pre-med students

Guidance with overcoming hardships throughout the application process

Someone to ask occasional questions to as they arise

Other:

Required

Do you have any of the following experiences? Please keep in mind that we ask this question solely for the purpose of matching you with a mentor that may have some common experiences as you. Choose all that apply.

Research

Healthcare work experience

Military

Peace Corps

Teach for America

Volunteering in a medical capacity

Volunteering in a non-medical capacity

Non-medical post-graduate work experience

Other:

Please briefly expand on any of the above experiences or anything that was not included that you think may be helpful for us to know.

Do you have any particular interests or passions within healthcare? (e.g. rural medicine, wilderness medicine, working with a particular population, medical research, particular specialities or interests, health law and policy, healthcare management, etc.)

Do you have any specific concerns about applying to medical school that you would like to discuss with your mentor?

Is there anything you would like us to take into consideration when matching you with a mentor? This could be anything from same gender, also identifies as URiM, or any other characteristics that are important to cultivate a beneficial mentorship experience for you.

If you know someone at UWSOM that you would like to have as your mentor, please include their name here. We will do our best to match you with your preference, but cannot guarantee their availability.

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