Dr. Rubin's Mini Medical School Summer Experience Program Application
Our summer experience program provides an overview of a typical medical school with an emphasis on clinical information. This program is designed for students entering high school through students in college. We offer a separate program for middle school students.

Due to the current pandemic, last summer we changed our format to prevent the spread of COVID19. Dr. Rubin recorded six half hour lectures for home viewing on your computer. After viewing these lectures, students will be able to experience all of our clinical and procedural experiences. However, instead of being in groups of 4-6 students and rotating stations, we will have 8-10 students in a large lecture room allowing for 6 or more feet of separation. Students learn from their own station. Instead of meeting at the Edward-Plainfield ER Conference Rooms, we have arranged to meet at the Naperville Campus of Northern Illinois University. To accommodate students in small groups, we will meet for 4 hour sessions on the weekends of June 26/27.

Since the program is not all day we will provide water and cookies - nut and meat free. Students will get a certificate of completion at the end of the hands on session.

Our application process is simple and has 3 steps:
Step 1 - Submit this form online. Once received an automatic email will be sent to you with a consent form.
Step 2 - Print and complete the consent form.
Step 3 - Mail your signed consent form along with your program fee of $250 to us. At this time, we are only able to accept checks, no credit cards.

Applicants are accepted on a first come first served basis once we receive your online application, your parent permission form and your program fee, you will get an email confirming your registration.

Due to the COVID19 pandemic, we will refund our program fee for any student who is unable to attend, for any reason, as long as we are notified in writing no later than the week before the program. In addition, we will refund all program fees if we are not able to run the program for any reason, including pandemic related issues.
Welcome to Dr Rubin's MIni Medical School Summer Experience Program. Ready to apply?
What is your name? *
Print your legal name - Not a nickname - Both First Name and Last Name ** this is how your name will appear on your certificate. PLEASE CHECK YOUR SPELLING
Which day do you want to attend? *
We offer identical programs on Saturday and Sunday - No preference gives you a better chance of acceptance. As of 5/18/20, our June programs are full. If you wish to attend check the other box and we will contact you if a spot opens in June.
What is your phone number? *
What number should we call if we need to contact you?
What is your email? *
Where should we send information? Please double check your spelling for accuracy.
What is your address? *
Please indicate your full address including street number, street, city, state and zip code
What grade are you currently in? Students currently in grades 5, 6 or 7 are not appropriate for this program. They must apply to our middle school program. *
What is the name of your school? *
What is your GPA?
If you don't know or have an official GPA, please provide your best estimate.
Is there anything you need to tell us? For example - do we need to know that you are allergic to something or need to leave early or arrive late?
Please provide the name of a parent (First and Last Name) *
Please provide the email of your parent *
Please provide a phone number for your parent *
DIGITAL SIGNATURE: By typing in your name you hereby indicate that the information provided is accurate to the best of your ability.
A student or parent may sign.
Once all required fields are completed you will be able to press the submit button to send us your initial application. This form will not send if all fields are not completed. A message will pop up once the form is saved. If you don't see that message, you have not completed all required fields. The pop up message has a link for you to download your parent permission form. Print the form and mail it to us with the program fee. It is your responsibility to make sure we get the parent consent and program fee. Please keep in mind that we will accept students on a first come first served basis. Submitting this form does not guarantee we have space for you. We will email you once we get the parent form and program fee. Once received, we will confirm your acceptance into the program.
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