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Young Physician Initiative
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* Required
Introduction Survey
School Name
*
Please select your specific school
Choose
Clarkston High School
Academe of the Oaks
Druid Hills High School
Drew Charter High School
Georgia State University- Atlanta Campus
Georgia State University- Clarkston Campus
Georgia Institute of Technology
Clark Atlanta University
Agnes Scott College
East Tennessee State University
Middle Georgia State University
Hutchings College and Career Academy
Fort Valley State University
Northview High School
Tucker High School
AU/UGA- Athens Community Career Academy
Altamont School
Uncommon Schools Roxbury Prep High School - Upper Campus
Name
*
Your answer
Pronouns
Please type your pronouns below. Ex: he/him, she/her, she/they, they/her, they/them
Your answer
E-mail
*
Your answer
Phone Number
Your answer
Age
*
Your answer
Gender
*
Male
Female
Non-binary
Other:
Race
*
Black
White
Asian
Hispanic/Latinx
Other:
High School or College Level
*
Freshman (1st year)
Sophomore (2nd year)
Junior (3rd year)
Senior (4th year)
Have you had formal exposure to medical experiences before this program?
Yes
No
Clear selection
How interested are you in becoming a doctor?
Very interested
Interested
Slightly interested
Not interested
Clear selection
How confident are you in applying for medical school in the future?
Not confident at all
1
2
3
4
5
Very confident
Clear selection
Please select your top 3 concerns about obstacles you face in becoming a doctor:
The process takes too long
It is too competitive
It is too expensive
I have other responsibilities that take up my time
I am interested in other careers
It might take me further away from my family than I can or want to go
I am worried my grades are not good enough
I have no concerns
How many years is medical school?
1 year
2 years
3 years
4 years
5 years
Don't know
Clear selection
Which is the required test to apply for medical school?
SAT
MCAT
DAT
GMAT
USMLE
GRE
PCAT
Don't know
Clear selection
Do you have to be a science major in college to become a doctor?
Yes
No
Don't know
Clear selection
What are your plans for after graduation?
Your answer
What are your future goals?
Your answer
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