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Professional Student Mentor Application:
Spring 2023 Pre-Health Mentoring Program
Please visit our
Pre-Health Mentoring
page for program details.
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* Indicates required question
First name
*
Your answer
Middle Name/Initial
(leave blank if preferred)
Your answer
Last name
*
Your answer
email
*
Your answer
Phone Number
*
Your answer
Race/Ethnicity
*
Choose
American Indian/Alaska Native
Asian
Black or African American
Hispanic/Latino
International
Native Hawaiian/Pacific Islander
Not Available
Two or More Races
White
Prefer not to say
Age
(optional)
Your answer
Do you consider yourself a non-traditional student?
*
Yes
No
Maybe
Did you take a gap year after completing your BS or completed a Post Baccalaureate program?
*
Yes (gap year)
Yes (completed post-bac)
No
Are you a first-generation college student?
*
Yes
No
Are you a resident of the state of Arizona?
*
Yes
No
What is your preferred method of communication? (Select all that apply)
*
Phone
Email
Zoom
In-Person
Required
Graduate program and school (ex: Medicine/A.T. Still University School of Osteopathic Medicine)
*
Your answer
What medical credentials are you pursuing?
*
Choose
Medical (M.D.)
Medical (D.O.)
Physician Assistant
Physical Therapy
Occupational Therapy
Dental
Optometry
Pharmacy
Veterinary
Naturopathic
Chiropractic
Podiatry
What year are you in the graduate program?
*
Your answer
What are your hobbies/what do you like to do for fun?
Your answer
How will you make time for meeting with your mentee?
*
Your answer
What is your availability during the spring 2023 semester?
*
Your answer
If selected, what type of experience would you like to gain from participating in this mentoring program?
*
Your answer
If there is anything else you would like to share with your future mentee, please do so at this time.
*
Your answer
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