Future Superhero of Medicine Funding Request
Supporting programs that empower and encourage Black students and students from other communities that are under-represented in medicine to pursue careers in health and medicine
I affirm I am a Black student or a student from another community that is under-represented in medicine student pursuing a career in health and medicine.
I am enrolled at, or intend to apply to, medical school in Wisconsin?
Name of individual completing this application
How would you like to be addressed in correspondence?
A copy of your responses will be sent to this address.
Street Address Line 2
State / Province
Postal / Zip Code
Please provide the name of your current school? (If applicable.)
What is your expected year of graduation? (If applicable.)
Please briefly share what your future career plans are specifically related to health and medical fields and why you are pursuing this path:
What have been some of the barriers in your way to pursuing a career in medicine and what things do you wish were in place to better support you:
What is your connection to the State of Wisconsin or to practicing in Wisconsin?
Please indicate which 90 day UWORLD Qbank Subscription you are applying for access to:
Step 2 CK
Please verify that you are human
Should be Empty: