AMSA 2018-2019 Local Application
The University of California, Merced Chapter

Please fill out as much information as possible as this application is used to guide funds toward workshops, events, etc, so please fill it out to the best of your ability.

If you have any questions feel free to email our Vice President of Membership Kyle Rekedal at:

General Information
First Name *
Your answer
Last Name *
Your answer
UCM Email *
Your answer
Your answer
Phone Number *
Your answer
Do you have an AMSA National ID? *
Class Standing *
Major *
Your answer
Your answer
Are you a Transfer Student? *
Shirt Size *
If you have an AMSA National ID, please enter it below
Your answer
Member Interests
Are you a new or returning member? *
What are your currently plans after you graduate? *
What specialties are you interested in? *
Do you have any certifications? *
Based on the answers above, do you understand how to achieve your goals? (getting into med school, graduate school, etc) *
What are some things you would like to see this semester to help you achieve your goals? (Being a competitive medical school applicant workshop, PhD workshops, Medical School Visits, Research seminars, etc.) No answer is a bad answer so make as many suggestions as you would like! *
(Keep it short)
Your answer
For the next few questions, please answer what fits best.
Are you familiar with the MCAT? *
Would you like to learn more about the MCAT? *
Are you familiar with the GRE? *
Would you like to learn more about the GRE? *
Have you had research experience? *
Shadowing Experience *
Volunteering & Internship Experience *
Have you ever attended a Pre-Health or Pre-Medical Conference? *
Would you be interested in attending the UC Davis Pre-Medical Conference? *
Academic Profile
All information will be kept confidential and is used to better support our programs and academic outreach for members
Cumulative GPA *
What Classes are you taking this semester? *
All Classes
Your answer
Returning Member Survey
Please fill out this section ONLY if you are a returning AMSA member
How long have you been in AMSA?
What did you enjoy about your previous AMSA experience?
(feel free to list any workshops, presentations, meetings you participated in that you enjoyed.)
Your answer
What did you not enjoy about your previous experience in AMSA, if any?
Your answer
Additional Comments and Suggestions
This sectional is optional, but it is HIGHLY recommended as it helps the leadership team to plan the best and most insightful experience for members that we can provide
Would you attend the retreats that we hold each semester?
Would you like to see more retreats each semester?
(we normally have one)
What kind of retreat would you like to see?
What type of meeting events and activities do you prefer?
What are some things that you would like to see in the upcoming year?
Your answer
What are something that you would like to gain through your membership and involvement with AMSA?
Your answer
We want to build a fun, inclusive, and professional environment for all members. How do you feel about ice breakers to get members to know one another better?
Feel free to leave suggestions for ice breakers!
Additional Comments and Suggestions?
Your answer
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