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JMSA Shadowing & Mentorship Program (For MEMBERS-IN-TRAINING)
Thank you for taking the time to fill out this 2 page survey.
Members-in-training include those who are: high school students, undergraduate students, post-college students, graduate students, medical students, residents, fellows, and international (i.e. Japanese) students.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Are you a JMSA Member?
*
In order to shadow, you must be a JMSA member. Membership is free for students.
Yes
No
Not yet, but I will become a member
Email
*
Your answer
Phone Number
*
Your answer
Are you interested in the shadowing or advising mentorship program?
*
Shadowing only
Advising only
Both
What is your current member-in-training (i.e. student) status?
*
Please check as many as applicable.
High School Student
Undergraduate Student
Post-Bac/Masters/Graduate/PhD Student
Medical Student
Resident
Fellow
International (i.e. Japanese) Student/Resident
Other:
Required
High School (City and Year)
*
Your answer
Undergradaute College (Year)
Your answer
Medical School (Year)
Your answer
Residency Institution (Specialty and Year)
Your answer
Fellowship Institution (Specialty and Year)
Your answer
Future academic aspirations
*
Max 500 characters
Your answer
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