Rural Outreach & Mentorship Initiative: High School Student Mentee Sign-up
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 goal of providing mentorship and support for youth living in rural and remote communities!

Currently, ROMI is offering free one-on-one mentorship for high school students 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.

To be matched with a medical student mentor, please complete and submit the following form:
Sign in to Google to save your progress. Learn more
Email *
What is your name?
 *
What are your pronouns?
Preferred language?
 *
Where are you from? (Town, Province/Territory) 
 *
What grade are you in  *
Do you have access to a computer/phone/internet?

 *
When would be the best time to participate in mentorship activities?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
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:
Do you wish to be matched with a mentor who identifies as any of the following? Feel free to specify or add options in "other".
Optional. If you would like to be matched with a mentor who shares a similar identity or lived experiences, you have the option of making a request by answering this question. We cannot guarantee that we can accommodate the request but we will make every effort.
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
Google Forms