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Application


Contact Information
First Name     Last Name    
E-mail Address     Preferred Phone #    
 
Background Information
School Year    
Hometown     High School    
University/College(s)    
(separate with commas)
Major(s)    
(separate with commas)
 
Mentoring Info/Preferences
I plan on applying to medical school    
I have applied or plan to apply to these medical schools:    
(up to 7 schools separated by commas)
Mentor request(s)    
(e.g., male/female, Imi Ho`ola graduate, specific name) separated by commas:
We will make every attempt to accomodate requests but cannot promise they will be honored.
I intend to participate in all program get-togethers    
I intend to keep in touch with my mentor in other ways besides email    
I anticipate needing a significant amount of mentoring this year    
I would like to have a mock interview by a medical student this year    
I would like to have my medical school personal statements reviewed by a medical student this year    
Any other mentoring requests:    
 
Please review your information (above) and read the following (below):
YES, I am interested in having a medical student mentor!

As a mentee, I agree to make contact with my mentor at least ONCE A MONTH for the remainder of the academic year. This can be done via phone, email (emails must be returned within 7 days), or face to face. I will also meet my mentor on at least one occasion during this academic year.

I also agree to pay the membership fee of $ 10 for this academic year.




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Questions? Email msmp.jabsom@gmail.com