Mentorship and Recuritment

Thank you for your interest in participating in student recruitment and mentorship projects for students and recent graduates—with a special focus on those underrepresented in medicine (URiM). This effort is a collaboration between the Alumni Council, Office of Alumni Affairs and Development (AAD), and Office of Recruitment and Multicultural Affairs (ORMA).

By completing this survey, you give AAD permission to share the contact information and biographical details you provide with ORMA. This information will be used solely for recruitment and student and recent graduate support and will not be shared with other departments or programs.

By selecting “I agree,” you are consenting to the conditions above.

I agree
I disagree

Thank you for your consideration. Please provide the information below so we can remove you from future notifications about this survey.

First name:

Last name:

HMS graduation year:

Email address:

Are you interested in partnering with ORMA to support student recruitment?

Yes
No

Select the activities you are interested in (select all that apply):

Appearing in ORMA-produced webinars for pre-med students
Volunteering for the Empower Conference: A Symposium on Underrepresented Voices in Medicine for pre-med students
Welcoming admitted students
Being a resource for ORMA staff to help reach pre-medical students through my professional academic institution (if selected, provide the name of your academic institution)

Are you interested in partnering with ORMA and AAD to support current students and recent graduates?

Yes
No

Select the activities you are interested in (select all that apply):

Serving as a resource for current HMS students
Serving as a resource for HMS URiM students only
Joining group URiM student topic discussions
Volunteering as an adviser for recent HMS graduates
Volunteering as an adviser for HMS URiM recent graduates only

We want to know more about you to better match you with our students and recent graduates. Answer to the extent you are comfortable.

Ethnicity (check all that apply, including “other”):

American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, or of Spanish origin
Native Hawaiian or other Pacific Islander
White
Other
Prefer not to answer

What pronouns do you use?

Do you identify as a member of the LGBTQIA+ community?

Yes
No
Prefer not to answer

Gender identity:

Do you identify as first-generation?

Professional title:

Company:

Specialty:

Business city:

Business state:

I can offer advice on the following topic(s) (e.g., women in medicine, industry, career change, private practice):