First Name

Last Name

Email Address

What university do you attend? What university do you attend?University of British ColumbiaUniversity of CalgaryUniversity of AlbertaWestern UniversityMcMaster UniversityUniversity of TorontoUniversity of WaterlooNone - High SchoolOther

Please Specify

What year are you in? What year are you in? High School 1st year 2nd year 3rd year 4th year 5th Year Masters Student PhD Candidate Other

Please Specify (Year)

Are you a non-traditional/mature applicant, and would like to be matched with a non-trad/mature student? Are you a non-traditional/mature applicant, and would like to be matched with a non-trad/mature student? Yes No

Please describe your non-traditional background

Please write the name of the mentor(s) you would like to be paired with! We will do our best to accommodate your preferences.

How did you hear about us? How did you hear about us? Facebook Instagram Humanities in Healthcare Word of mouth Other

Please specify how you heard about us