The 2nd Annual CUMC Virtual Information Session

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* 1. Contact Information

First Name

Last Name

Email Address

State of Permanent Residence (Please abbreviate, i.e. AZ, NY, etc.)

College/University

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* 2. Current status

First Year Student

Sophomore

Junior

Senior

Postbacc Student

Recent Graduate

Advisor

College/University Professor

College/University Administrator

Other (please specify)

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* 3. Which program are you interested in? Select all that apply.

Summer Medical & Dental Education Program

Summer Public Health Scholars Program

NERA MedPrep Program

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* 4. Do you plan on attending the virtual fair on November 20th, starting at 5 PM?**

Yes

No, but please send me additional information via email.

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* 5. How did you find out about the CUMC virtual information session?

Facebook

Listserv

Email from friend

Email from university employee (professor, academic advisor, etc.)

Other (please specify)

**Please note that only the first 500 registrants will be able to join the Virtual Information Session due to technological limitations. All additional registrants will be sent the link to a recording of the session with additional program information.