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Camino a la Medicina Program
High-school Student Interest Form
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* Indicates required question
Name and last name
*
Your answer
Grade level
*
9th
10th
11th
12th
School name
*
Your answer
Are you interested in a health care career?
*
1
2
3
4
5
Which statements fits you best? Choose 2)
*
I am certain I want to be a physician (Medical Doctor)
Exploring medicine vs other healthcare careers
Not sure but curious
Which careers are you interested in (select all you need)
*
Physician (Medical Doctor)
Nurse
Pharmacist
Dentist
Physical therapist
Psychologist
Public health
Biomedical research
Health IT
Health engineering
Other:
Required
Current GPA
*
Your answer
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