Young Physician Initiative
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Introduction Survey
School Name *
Please select your specific school
Name *
Please type your pronouns below. Ex: he/him, she/her, she/they, they/her, they/them
E-mail *
Phone Number
Age *
Gender *
Race *
High School or College Level *
Have you had formal exposure to medical experiences before this program?
Clear selection
How interested are you in becoming a doctor?
Clear selection
How confident are you in applying for medical school in the future?
Not confident at all
Very confident
Clear selection
Please select your top 3 concerns about obstacles you face in becoming a doctor:
How many years is medical school?
Clear selection
Which is the required test to apply for medical school?
Clear selection
Do you have to be a science major in college to become a doctor?
Clear selection
What are your plans for after graduation?
What are your future goals?
Clear form
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