Medcoach 2020 Mentee Sign-up Sheet

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This form is meant to match you up with a mentor most alike your background, so that you can have the best advice fitted to your circumstances. This information will not be shared or used for any other purpose other than matching you with a mentor. If you have a specific preference for a mentor like gender, ethnicity, etc, please answer questions marked (optional). If you have no preference, leave empty.

Email *

What is your name? *

What is your major/program? *

What is your residency status? *

In state

Out of state

International

If you have had a mentor through MedCoach and would like to keep your mentor from last year, please enter their name below:

Ethnicity (Optional):

White

Hispanic/ Latinx

Black/ African American

Native American/American Indian

Asian/Pacific Islander

Prefer Not to Say

Other:

Clear selection

Gender Identity (Optional):

Female

Male

Transgender

Other:

Clear selection

Would you prefer a mentor with Research Experience? (Optional)

Yes

Clear selection

Send me a copy of my responses.

Submit

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