Exit 2025 PrIMES Application - Cycle 6 Question Title * 1. What is your first name? Question Title * 2. What is your last name? Question Title * 3. What is your primary email address? Question Title * 4. What is your primary phone number? Question Title * 5. What is your gender? Female Male Other/Non-Binary Prefer not to answer Question Title * 6. What year are you in your education / college? First year college student / Freshman Second year college student / Sophomore Third year college student / Junior Fourth year college student / Senior Fifth or higher year college student / post-Senior year Graduated college / post-bac student Question Title * 7. What college or university do you / did you attend? Question Title * 8. In what state is your college located? Question Title * 9. In what city is your college located? Question Title * 10. What is your race / ethnicity? Black / African-American Hispanic / Latino Caucasian / White Asian Native American / First Nations Other/Mixed, but including black, Latino, Native American, and/or Pacific Islander ancestry Other/Mixed, WITHOUT any black, Latino, Native American, and/or Pacific Islander ancestry Question Title * 11. Do you have children of your own? Yes No Question Title * 12. If you have answered “Yes” to the previous question, do you have access to childcare (daycare, family help, etc.) Yes No N/A – no children Question Title * 13. Do you have family responsibilities (i.e. babysitting siblings or caring for other family members)? Yes No Question Title * 14. If you answered “Yes” to the previous question, about how many hours per week do you spend taking care of your family responsibilities N/A – I do not have any family responsibilities 0-5 hours per week 6-10 hours per week 11-15 hours per week 16-20 hours per week Over 20 hours per week Question Title * 15. Do you currently have a job? Yes No Question Title * 16. If you answered “Yes” to the previous question, how many hours per week do you spend working? N/A – I do not have a job 0-5 hours per week 6-10 hours per week 11-15 hours per week 16-20 hours per week Over 20 hours per week Question Title * 17. Are you currently involved in another program for historically under-represented pre-medical students? Yes No Question Title * 18. How strongly are you interested in attending medical school? Not at all interested in attending medical school Somewhat interested in attending medical school Strongly interested in attending medical school Extremely interested in attending medical school Question Title * 19. Are you prepared to commit time each week to meet with a Mentor 2hr. per week, work to set and meet goals, keep pace with suggested with unit timelines, and maintain timely correspondence and assesments? Yes No Question Title * 20. Would you be able to commit up to 1hr per week to attend PrIMES academic and social events? This will be in partnership with AAMC, Guest Speaker, Chat and Chew Sessions, Study abroad sessions, Certification sessions Yes No Question Title * 21. How will becoming a PrIMES Mentee help you achieve your career goals? Done
