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UMN Department of Urology- Underrepresented in Medicine (URiM) Medical Student Scholarship
Thank you for your interest in the URiM Medical Student Scholarship provided by the University of Minnesota Department of Urology.
Your responses will be kept private and secure. If you have any questions regarding this scholarship, please contact Jasmine Jackson at
jacks589@umn.edu
.
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Email
*
Your email
Acknowledgment: I understand that this scholarship is for the 2023-2024 academic school year and for an away rotation at the University of Minnesota in the Department of Urology.
*
I have read and understand the above statement.
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Full Name
*
Your answer
Email
*
Your answer
Gender Identity:
*
Male
Female
Non-Binary
Transgender Male
Transgender Female
I choose not to disclose
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Preferred Pronouns
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He/Him/His
She/Her/Hers
They/Them/Theirs
Name only
I choose not to disclose
Other:
Option 2
Required
Race:
*
Asian
Black/African American
Hmong
Hispanic/Latino
Native Alaskan
Native American
Native Hawaiian/Pacific Islander
White
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Describe your unique connection with being underrepresented in medicine if other than race:
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