Pharmacy Residency Mentee Form
Email *
First and last name *
What are your pronouns? *
We are collecting the following information for two purposes: To better match you with a mentor with shared life experiences, and to assess our goals for reaching underrepresented applicants. These data will only be seen by Project SHORT committee members. Aggregate counts and percentages may be released, but we will never share or sell your personally identifying information at any point. You may select "prefer not answer" to any questions you do not wish to answer.
In which country do you currently reside? *
In which state do you currently reside? *
How Old Are You? *
Undergraduate university (please include full name, no acronyms) *
What is/was your undergraduate major? *
PharmD university (please include full name, no acronyms) *
What is your current educational status? *
What is the highest level of education your parents/guardians completed? *
Some High School
High School
Vocational/Technical Training
Some College
Associate's Degree (Two-year College)
Bachelor's Degree (Four-year College)
Prefer not to answer
Parent/Guardian 1
Parent/Guardian 2
Parent/Guardian 3
Parent/Guardian 4
For Which Application Cycle Are You Applying? *
Areas of Interest *
How Well Do You Think Your Experiences Prepared you for This Program? *
How familiar are you with the resources available to help you with your application process (other than Project SHORT)? *
Which services are you interested in receiving? Check all that apply.
Where do you plan to apply? Check all that apply. *
Do you identify as any of the following? (Please check all that apply – but do not feel obligated to disclose anything you are not comfortable sharing.) *
What race/ethnicity(ies) do you identify with? Check all that apply. *
What is your gender? *
Do you have any physical or mental disabilities? *
How would you define your family of origin's class? *
How would you define your current class? *
One of the goals of Project SHORT is to mentor and support applicants of diverse experiences and backgrounds. How do you as an individual contribute to diversity in STEM? (4-5 sentences) *
Project SHORT aims to combat socioeconomic and systemic inequalities in medical and graduate school admissions. What barriers do you face in applying to medical/graduate school? *
Please provide any other relevant information you believe may help us match you (e.g. undergraduate institution, socioeconomic background, career goals, etc).
How did you hear about us (check all that apply)? *
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