Medical Mentor In-person Event 2/28/25
The UCF School of Medicine has offered us the opportunity to bring 10 students to their campus at 6850 Lake Nona Blvd, Orlando, FL 32827 for an evening of hands on experience and mentoring from medical students and professors. This will be held on Friday, February 28th from 4:30pm to 6:30pm. Transportation to and from  is the responsibility of the student. Because this is an event with limited availability we are asking for firm commitments for attendance. Should your ability to attend change prior to the event, please contact The PLUG so that your seat can be offered to another student.  If you have any questions, please email info@theplug4connection.org.  If at any time you should have concerns with the program provided, please contact our Director of Programs at info@theplug4connection.org to receive a Client Grievance Form. 
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First and Last Name *
Gender *
Date of Birth *
Address including Zip Code *
Race *
Phone Number *
Email Address (personal only, no student 480 emails) *
Current Grade  *
Name of your parent or guardian? *
Parent or Guardian's Phone Number
Parent or Guardian's Email Address *
What OCPS School do you attend?  *
Can you commit to attend this event and in the event you are no longer able to attend will you commit to notifying The PLUG immediate?  *

By typing your name below, you are providing an electronic signature to confirm that you are aware that because of grants provided by Orange County for the funding of our agency, the County can have access to any and all protected health information and personally identifiable information provided to our agency for the purposes of auditing The PLUG. 

Additionally upon your registration, The PLUG will conduct a review of our records and may contact you for further consent forms if necessary. *
By typing your name below, you are providing an electronic signature to confirm that the information you provided is correct and that you understand you have provided it to The PLUG 4 Connection to be used only within the purposes of the programs provided by The PLUG to you or your student.  *
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