Mentee Preference Form

Your name

Your email

Your phone number

Please type out the full name of your high school (i.e. Lindbolm Math and Science Academy)!

Location of High School (city)

Location of High School (state)

Your year in High School

What gender do you identify as?

Would you prefer someone with the same gender identity as you? Please note we will try our best to match you with someone of your preference but we cannot guarantee it.

Your racial identity

Would you prefer someone with the same racial/ethnic identity as you? Please note we will try our best to match you with someone of your preference but we cannot guarantee it.

Are there other identities you find important for you to share with your mentee? If so, please list them below.

What would you hope to gain out of this mentorship? In other words, how do you think we can help you most?

What are some of your career interests and goals in healthcare? Please list your career interests and goals as keywords with commas between each one: [Interest 1], [Interest 2], etc. Examples of career interests and goals include health equity, women's health, research, etc.

What are some of your hobbies and interests outside of medicine/healthcare? Please list your keywords with commas between each one: [Interest 1], [Interest 2], etc. Examples of interests outside of medicine/healthcare include sports, music, dance, etc.

Please enter information about your schedule that will help us match you with the best tutor! Information includes what days/times you are available, whether you prefer in-person and/or virtual mentorship, etc.

Please indicate the ideal number of hours you'd like to meet per week with your mentor

If you were an ice cream flavor, what ice cream flavor would you be and why?

How did you hear about us?

Anything else you'd like us to know?

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