Take on College Pre Med Mentoring Sign Up Request
Please fill out this form so we can match you with a mentor
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Email *
First Name *
Last Name *
What year are you in university? *
What year do you intend to start medical school? *
Phone Number (US text- XXX-XXX-XXXX) *
What topics would you like to discuss with your medical student mentor? (select all that apply) *
Required
What state are you from? (For our map!) *
What country are you from? *
Preferred Pronouns (ex: she/her, they/them, he/him) *
Are you a First-Generation Student? (meaning neither of your parents have graduated with a 4 year bachelor's degree) *
Do you qualify for need-based financial aid? *
Race *
Required
What is your major? *
Would you prefer to schedule a video meeting with us? *
If you are under the age of 18, does your parent/guardian consent to your participation with Take on College? *
How did you hear about Take on College? (select all that apply) *
Required
Next Steps:
After submitting this form, we will reach out to you with a mentor match within the next couple weeks!
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