Undergraduate students and recent graduates that are underrepresented in medicine are invited to apply to the Medical Mentorship Program.

The AAMC defines “underrepresented in medicine” as: “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” Our definition is broader and also includes first generation college students, those that come from low-income families and other disadvantaged backgrounds. If you are a pre-med student and meet one of these criteria, please apply.

The Medical Mentorship Program provides accepted students with mentorship, MCAT test prep support, and assistance with MD and DO applications to help students apply and be successful in medical school.

Medical Mentorship Program Mentee Application

SECTION ONE: GENERAL INFORMATION

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Preferred Method of Communication

Race/Ethnicity (optional)

Date of Birth

YYYY

SECTION TWO: BACKGROUND INFORMATION (this information is confidential and will be kept secure)

College/University

Current year

Degree/Major

Expected Graduation Year

GPA

Have you taken the MCAT?

Yes

If not, when do you expect to?

If you have taken the MCAT, what is your score?

Do you plan on retaking the MCAT?

Yes

Are you interested in MCAT prep courses?

Yes

SECTION FOUR: MENTORING INFORMATION

Do you have experience shadowing a physician?

Yes

Is there a specific mentor you would like to be paired with? If so, list their name below:

How often would you like to talk with your mentor?

APPLICANT RESPONSE QUESTION

How can the Medical Mentorship Program be most helpful to you?

What are some things you are most interested in?

Your participation is confidential and voluntary. You may choose not to participate or to withdraw as a mentee at any time without penalty. Your thoughts and messages and personal information will be kept confidential. Your privacy will be protected to the maximum extent allowable by law.

Medical Mentorship Program Mentor Application

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Preferred Method of Communication

Race/Ethnicity (optional)

SECTION TWO: BACKGROUND INFORMATION (This information is confidential and kept secure.)

Undergraduate College/University

UG Graduation Year

Degree/Major

Are you the first in your family to attend college?

Yes

Do you have a graduate degree?

Yes

If you answered “Yes” to having a graduate degree, please complete the following:

Graduate School

Degree

Masters

Phd

SECTION FOUR: MENTORING INFORMATION

What is your level of comfort with mentoring another student?

How would you prefer to be in contact with your mentee?

Remotely

In-person

Both, or no preference

What activities or jobs were you involved in as an undergraduate student?

Did you take a gap year before continuing your studies after college? If so, what did you during your time off?

What are some things you are most interested in?

Your participation is confidential and voluntary. You may choose not to participate or to withdraw as a mentor at any time without penalty. Your thoughts and messages and personal information will be kept confidential. Your privacy will be protected to the maximum extent allowable by law.

Hopa Mountain’s Medical Mentorship Program is offered in partnership with the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) Regional Medical Education Program. Monthly online meetings provide opportunities to learn more about how to apply to medical school. Pre-med students receive mentoring from first-year WWAMI students, test prep support, and assistance with applications.