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YPI VMC Leader Application
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* Indicates required question
Full name:
*
Your answer
Medical School:
*
Your answer
Year in Medical School:
*
MS1
MS2
MS3
MS4
Identify myself as
*
Hispanic
Black
White
Native American
Asian
Refugee
Underrepresented American
Disadvantaged socio- economic background
Other:
Email:
*
Your answer
Secondary email:
*
If you entered your school email above then it will be good to have your personal email for future records so you can stay connected with YPI after graduation.
Your answer
Phone number:
*
Your answer
Agree to download WhatsApp
*
YPI-VMC main platform of communication is WhatsApp. Please make sure you download it and are able to use it.
Yes
No
Why do you want to be a YPI-VMC mentor? (200 word max)
*
Your answer
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