AED Mentee Form

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AED Mentee Form

PROCESS:

This form will be used to gather information on our pre-med mentees. The mentors are also filling out a form.

We will FIRST match mentors and mentees for mentors who prefer this and after that other mentors will be able to sign up for mentees that they believe they match well with.

After matching, mentees will be responsible to reach out to mentors to introduce themselves. We will provide you with the contact information of the mentor.

We canNOT guarantee a mentor. We will be matching based on the characteristics and interests listed in this form. Ability to assign everyone a mentor will be dependent on how many mentors sign up and how many mentees they want.

For this program we are hoping that mentees and mentors meet 2-3 times a semester with at least one meeting being in person.

First Name *

Last Name *

Email *

Phone Number *

Preferred method of contact *

Text

Classification *

Freshman

Sophomore

Junior

Senior

Post-baccalaureate

Major *

Minor

Check the classes you have taken or are currently taking *

Intro to Bio 1

Intro to Bio 2

Gen Chem 1

Gen Chem 2

Genetics

College/University Physics 1

College/University Physics 2

Organic Chemistry 1

Organic Chemistry 2

Biochemistry

Required

When are you planning on taking the MCAT? *

When do you plan on applying to medical school? *

Do you plan on taking a gap year?

Yes

unsure

Clear selection

Do you have a medical school mentor preference (only choose if you ONLY want a mentor from a specific school and would not want one if you do not receive it from that school)

Baylor College of Medicine

McGovern

University of Houston College of Medicine

Clear selection

What is your goal in having a mentor? What topics are you hoping to discuss? *

How often would you like to meet with your mentor? Add if you prefer virtual or face-to-face meetings. *

Why are you interested in having a mentor? *

Special Topics that you are interested pursuing / seeing in a mentor *

Research

Dual Degree (MD/PHD, MD/MBA, MD/MPH, etc)

Community Service

Social Justice / Advocacy

Global Health

Medical Education

Gap years

Other:

Required

Hobbies? include any hobbies, interests, etc!

ex: plants, dog parent, soccer, cooking, video games, reading (can include type), etc

Any special considerations / factors? *

Financial Aid

Non-traditional medical Student ( ie. second career, children, etc)

Military

Minority Status

LGBTQ

Learning / Physical Accommodations

First-generation medical student

Other:

Required

Do you have a medical specialty you are very interested in

( please only put this if you are wanting a mentor in a specific specialty or have a high interest in a single specialty as mentors may be influenced to choose / not choose based on this )

Add any other information you would like your mentor to know.

Submit

Clear form

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