Apply – Medical Enhancement Programs

Which program dates are you applying for?*

Other program dates of interest? (if applicable)

If the program does not meet minimum enrollment requirements, it may be canceled. In such cases, students will have the option to transfer their reservation to another available program date.

Exclusive ID#:

(Are you applying for a program reserved by an organization/group? If so, enter the organization's Exclusive ID# here.)

Name:*

First: Last:

Exactly as shown on your passport*

Preferred Pronoun:

Preferred Name/Nickname:

Email 1:*

Email 2:

Home Phone:*

Cell Phone:*

Current Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth:*

Birthplace:*

Gender Identity:*

Legal Residence State:*

State / Province / Region

Are you a U.S. Citizen or have permanent residence in the U.S.?*

How did you hear about us?*

Have you previously attended any other medical mission trips?*

Yes
No

Affiliation to any student organization or group?

PARENT/GUARDIAN INFORMATION

Name:*

First: Last:

Relation:*

Phone:*

Email:*

Occupation:

OTHER INFORMATION

What languages do you speak?

Are you a first-generation college student?

List any awards, honors, certifications, medical experiences, etc.:

HIGH SCHOOL EDUCATION

High School Name:

Graduation Year:

Address:

UNDERGRADUATE EDUCATION

Name of Institution:*

City: State: Country:

Dates of Attendance:*

Major:

Minor:

Degree Pursued/Earned:

Expected Graduation Year:*

Overall GPA:

Career Plans:*

[Undecided, Medicine, Pharmacy, Physician Assistant, Nursing, Medical Research, etc.]

ESSAY

Please write an essay below.

Why are you interested in applying to a MedX Program?*

IMPORTANT:

Please upload transcripts and resume below.

Resume*

Max. file size: 50 MB.

Unofficial Transcript*

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

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File

Max. file size: 50 MB.

Comments:

Program Application

Application Form

PARENT/GUARDIAN INFORMATION

OTHER INFORMATION

HIGH SCHOOL EDUCATION

UNDERGRADUATE EDUCATION

ESSAY

IMPORTANT: