MyMentor Program Intake Form
Welcome to the MyMentor Program! Please fill out this quick form in order to help us match you up with the right mentor. Read more details about the MyMentor Program here: https://www.motivatemd.com/finding-mentor-in-medical-field/
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Correo electrónico *
First and Last Name *
Date of Birth
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Race/Ethnicity
Which year do you plan on applying to medical school? *
If you're in college, where do you attend?
Have you taken the MCAT? *
Please let us know if there are any factors that make you and your premed journey unique.
How would you describe your perfect mentor? (For example: Someone who considers themselves a part of an underrepresented group, from a small town, goes to "X" medical school, is  a non traditional premed, was in the military, etc.) *
Please check off the areas that apply to you *
Obligatoria
The challenges you've faced so far as a premed.
How often do you hope to communicate with your mentor? *
Is there anything else we should know in order for us to better match you up with one of our mentors?
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