Pre-Med Pathway Boot Camp by CVHEC & CHSU-COM

Question Title

* 1. Primary Email Address:

Question Title

* 2. First and Last Name:

Question Title

* 3. Mailing Address:

Question Title

* 4. Mobile Phone Number:

Question Title

* 5. High School Attended:

Question Title

* 6. Undergraduate Institution Attended

Question Title

* 7. Current Year in College:

Question Title

* 8. Major/Minor at Undergraduate Institution(s):

Question Title

* 9. Science GPA:

Question Title

* 10. Overall GPA:

Question Title

* 11. Anticipated Graduation Date:

Question Title

* 12. How did you find out about this program?

Question Title

* 13. Please describe your interest in becoming a DO or MD:

Question Title

* 14. Please list any health related certifications or trainings you have received and date of completion:

Question Title

* 15. What is one thing you hope to accomplish through the Pre-Med Pathway Boot Camp:

Question Title

* 16. If applicable, please list any special needs, learning impairments or considerations you would like us to be aware of:

Question Title

* 17. Are you committed to attending at least 75% of the Pre-Med Pathway Boot Camps held during weekends:

T