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Pre-Med Solutions Mentor/Mentee Application
Step
1
of
5
- Contact & Applicant Type
20%
First Name
*
Last Name
*
Date of Birth
*
MM slash DD slash YYYY
Mailing Address
*
Cell Number
*
Email Address
*
How would you prefer to be contacted?
*
Phone
Email
Other
Social Media Profiles/Handles (Minimum of 1)
*
Ex: LinkedIn/bridgetjoy
How did you hear about Pre-Med Solutions?
*
Social Media
Word of Mouth
School Club (SNMA/MAPS)
Website
Other
I am registering/applying as a...
*
Mentee
Current Medical Student Mentor
Resident Physician Mentor
Attending Physician Mentor
Please mark the appropriate academic selection:
*
Freshman
Sophomore
Junior
Senior
Post Bac
Other
Name of Undergraduate Institution Attended
*
BCPM (Biology, Chemistry, Physics and Math) GPA
*
All other GPA (Cumulative)
Year of graduation
Name of Graduate Institution Attended (If applicable)
Graduate BCPM GPA (If applicable)
Have you taken the MCAT?
*
Yes
No
If yes, how many times?
Highest MCAT Score achieved:
How did you prepare for the MCAT?
Have you participated in a pre-med summer program?
*
Yes
No
Have you participated in a post-bac program?
*
Yes
No
Will this be your first time applying to medical school?
*
Yes
No
What factors are you using in your selection of medical schools?
*
What are your geographical preferences for medical school?
*
What is your preferred learning style?
*
Visual Learner
Auditory Learner
Kinesthetic (Hands On) Learner
Identify any extracurricular activities in which you participated at your undergraduate and/or graduate institution(s).
*
Identify your strengths.
*
Identify areas where assistance is needed.
*
If you do not get accepted into medical school this application cycle, what are your plans?
*
Share something unique about yourself.
*
Upload Unofficial Undergraduate Transcript(s)
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload Unofficial Graduate Transcript(s)
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload Resume
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload Completed AMCAS and/or AACOMAS Application (If available)
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload Personal Statement
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload Professional Headshot
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Are you a member of a Divine 9 Greek Letter Organization? (for pairing purposes)
Yes
No
Are you a former S.H.A.D.O.W. Program or Pre-Med Solutions participant?
*
Yes
No
Are you willing to be mentored based on Pre-Med Solutions philosophy and other best practices for mentoring?
*
Yes
No
What is the name of the medical school you are currently attending or graduated from?
*
Where did you or are you currently doing your residency/fellowship?
What is your Specialty and/or Subspecialty?
*
Do you currently have an active license to practice medicine? (Med students select No)
*
Yes
No
If yes, please indicate the state:
If no active license, please explain:
Enter N/A if current medical student
Have you ever been suspended or disciplined from a hospital, state medical board, medical practice, academic institution, or other entity for unethical or illegal activity?
*
Yes
No
If yes, please explain the reason for your suspension/disciplinary action and outcome:
Have you ever been charged or convicted of a felony?
*
Yes
No
If yes, please provide a detailed description of the charges and the outcome of the case.
Please confirm your current training level to help us filter your tracking questions:
*
Medical Student
Resident Physician
Attending Physician
What year are you in medical school?
Example: OMS-III, MS-1
Are you in good standing at your medical school?
Did you have a good mentor when you were applying to medical school?
What institution is your residency program affiliated with?
Are you in good standing in your residency program?
What year are you in your residency program?
Example: PGY-2
Where is your current practice/job located?
What is your current job title?
Have you mentored any Pre-med students since entering your current level of training or in the last 5 years?
*
Yes
No
Do you have a good understanding of the "current day" medical school application and admissions process?
*
Yes
No
How many hours per month are you available to mentor?
*
Are you a member of a Divine 9 Greek Letter Organization?
*
Yes
No
If yes, please state which one:
How would you like for your name and credentials to appear on the website?
*
Please submit a brief biosketch:
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Upload a recent Professional Headshot
*
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Other documents (CV, etc.)
Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 25 MB.
Why do you think you would make a good mentor? (This will be displayed on the website)
*
Philosophy of Pre-Med Solutions: 1) Passionate about developing the next generation of Black and Brown doctors. 2) Treat every mentee with dignity, compassion, and respect. 3) Open, honest, and transparent. 4) Demand excellence, persistence, and determination. 5) Advise alternate pathways when appropriate. Are you willing to adopt the Pre-Med Solutions philosophy?
*
Yes, I agree to Pre-Med Solutions philosophy displayed above.
No
Disclaimer: By placing your initials below, you acknowledge that an initial consultation will be conducted, that services rendered do not guarantee admission, and that Pre-Med Solutions Team members are independent consultants. Please initial here:
*
Select Your Application:
Mentee
Mentee Application
Mentor
Attending Physician
Resident Physician
Current Medical Student
Home
About
Leadership Team
Mentors
Programs
Pre-Med Solutions
Pre-Med Solutions Prep
The SHADOW Program
A.I.M.
Success Stories
