Dr Rubin's Mini Med School Counselor Form
If you are the school  counselor of a student applying to Dr. Rubin's Mini Medical School for High School Students  program, you may use this online form.  This form is not for students or parents.

Please fill out all required fields (marked with a red *).  The form will only submit once all required fields are completed.  Once submitted a pop up message will confirm that the information is accepted.  Our student application deadline is Novembe 15th 2022 but we will accept online recommendations until December 15th.   We will only accept a recommendation from an official school email address.  The purpose of this form is to confirm the applicants enrollment and academic performance.

This form will only be accepted when submitted from an official school email account.  The information provided will not be shared and is confidential.

This year, due to the  pandemic, we are not requiring teacher recommendations and we  are accepting students on a rolling basis. Meaning the sooner we get this form, the sooner the student  gets a response.

Thank You for your support and advice to future physicians.

Ira S Rubin, M.D., Ph.D.
Founder and Creator of
Dr Rubin's Mini Medical School
A 501C3 private foundation
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Please print the student's name. *
First Name and Last Name - Do not use a nick name.
Please print the student's email address
Please print the student's phone number
Please print the name of your high school. *
Please  verify the student's  grade? *
Please note, we do not accept high school  freshman.
What is this student's GPA? *
If your school does  not calculate a GPA, please provide an unofficial GPA or the student's  transcript.  The transcript can be emailed to rubinminimedicalschool@gmail.com or faxed to 888-725-0506.  Please state in the space  below if you emailed or faxed a transcript.
What is the highest GPA in this student's class?
What is your name? *
Print the name of the school counselor submitting this form.  
What is your official school email?  We will use this email to contact you if a question arises. *
Digital Signature
By checking this box, you are confirming that you are the counselor submitting this form.  After submitting this form, you will get a confirmation on your official school email.
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