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* 1. First Name

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* 2. Last Name

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* 3. Designation (Pre-health area of study)

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* 4. R#

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* 5. Overall GPA

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* 6. Science GPA (Please provide the average of the sciences required by admissions to your professional program of choice. You may leave this field blank if you have not yet completed any sciences.)

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* 7. Personal Statement (Please describe how you would benefit from participation in this program.)

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* 8. Campus, Community & Professional Involvement (Please provide a brief description of any clubs, organizations, volunteer/shadowing, work experience you have. Include dates, hours, and a brief description of activities.)

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* 9. In terms of community involvement, what drew you to that/those particular volunteering role(s)? Why is community involvement and outreach important to you?

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* 10. Due to COVID circumstances some mentor/mentee matches may be entirely virtual. Please indicate if this is an acceptable format for you. (Yes/no, and any comments you may have about your own needs for a virtual/in-person format.)

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* 11. The mentor Program is for students who are not yet on their application semester for their designated health program. Please certify below that you have not applied, or are not currently applying this semester (fall 2021) for your health program.

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