Made for Medicine Student Application

Made for Medicine Student Application
Made for Medicine is an initiative focused on advancing health equity by attracting more talent to the medical profession through sustaining their pathway to medicine, delivering culturally responsive curriculum and providing access to faculty role models. The program is divided into 3 phases—Introduction to Medicine, Deeper Dive, and Commitment to Medicine—all of which provide students with critical foundational knowledge, hands-on learning, shadowing and much more.

This spring, we are welcoming twenty-five students in 7th grade who have an interest in becoming a physician.

Applicants to Made for Medicine should be 7th grade students who are curious, creative, committed, empathic, team-oriented, and have an interest in health equity. A brief short-response video interview is also required. Interview guidelines can be found on the Made for Medicine website under the Phase I application FAQs.

Upon acceptance, students are expected to actively participate in the Made for Medicine Program through to the completion of high school, as it is a longitudinal program. More information about the program requirements will be shared upon acceptance.

This application form ALONG WITH the teacher recommendation, current school transcript and video MUST be completed and submitted by Friday January 16, 2026 at 11:59 pm. Please note that you can only submit your application once so you need to have a copy of your grades/transcript and completed video when you apply.
Full Student Name*

First NameMiddle NameLast Name
STUDENT INFORMATION
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Cell Phone Number (if applicable)

Area CodePhone Number
Email (if applicable)
Gender*
Date of Birth (MM/DD/YYYY)*

MonthDayYear
School Attending*

School Name

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade*

7th Grade applicants only

Street Address Line 2

CityState / Province

Postal / Zip Code
Principal’s Name*

First NameLast Name
School Phone*

Area CodePhone Number
School Counselor’s Name*

First NameLast Name
School Counselor's Email *
example@example.com
Please list any leadership experiences you have had below.
Include the number of year(s) you have been a leader with this organization, club or group.
Please list all your extracurricular activities below.
Include the number of year(s) you have participated in this sport, organization, club or group.
How did you hear about Made for Medicine?
What size t-shirt do you wear?*
Based on unisex sizing
Please list any allergies or dietary restrictions.
i.e Dairy, nuts. Please put N/A if you do not have any allergies or dietary restrictions.
Are you able to commit to the entire 2 days of programming and concluding ceremony? February 21st 9am-3pm; February 28th 9am-3pm and White Coat Ceremony scheduled for March 2026? Please note that attendance for the full day on both days is mandatory.*

YesNo
PARENT INFORMATION
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Address (if not the same as above)

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Address (if not the same as above)

Street Address

Street Address Line 2

CityState

Zip Code
I give permission for my child's photo to be taken and used for any legal purpose such as publicity, marketing, or web content.*

YesNo
I recognize and acknowledge that there may be risks associated with my child’s participation in the Made for Medicine program, and in consideration for that participation, I agree to assume all such risks, including any damages resulting from physical injuries, death, loss or damage to property, or any other loss which my child may sustain as a result of participating in this program.

In consideration of Made for Medicine’s acceptance of my child's application to participate, and with the intent to be legally bound, I hereby, for myself, for my child, all heirs, executors, administrators, and assigns, do hereby forever release, waive and relinquish all claims I have or may have against Made for Medicine, their officers, directors, employees and representatives, from any and all liabilities, claims, demands, actions or causes arising from my child’s participation in this program.*
Signature of Parent or Legal Guardian

Clear
EMERGENCY CONTACT INFORMATION

List the name and address of two people we may contact in case of an emergency
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
REQUIRED: You must obtain a Teacher Recommendation

Please make sure to list a current teacher from this academic year. The teacher will be emailed the recommendation form within 48 hours of your application submission.
Name of Teacher Recommender*

First NameLast Name
School Name*

Street Address Line 2

CityState / Province

Postal / Zip Code
Teacher Email*
Must be a valid school email
Once you click “Submit” below, your teacher will get an email for a request to submit a recommendation within 48 hours. This email request will come from the program email, mfm@columbusmedicalassociation.org. Please be sure to follow up with the teacher to ensure that the recommendation form is completed. Please also direct the teacher to check their “junk mail” first if the form is not in their inbox.

Note: Your application is not considered complete until the teacher recommendation form is also submitted. You will receive an email notifying you that your application is complete.
REQUIRED: You must upload current academic transcript or grade card

Please upload PDF version of your current transcript or grade card from the 2025-26 academic year with current cumulative GPA and courses. If you have issues obtaining this document, please contact your school counselor.
File Upload*

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ESSAY QUESTIONS
Word Limit: 150 words or less. Responses are to be completed by students ONLY!
Tell us about yourself and how you first become interested in a career in medicine. *

0/150
Doctors make a direct impact on the communities where they live and work. Tell us about how you would use medicine to positively impact your community as a future physician. *

0/150
Is there anything that you would like to add or think that the review committee should know about you?*

0/150
Video Interview

Please upload your short response video interview below as a file upload or link. Video length should not exceed three minutes. The interview questions are: 1. What are you hoping to learn or gain from participating in the Made for Medicine program? 2. What do you think is the biggest health issue that impacts people today? And what do you think we can do to solve this problem?
File Upload

The video can be uploaded to this application as an HTML, ZIP, MOV or MP3 video.
Cancelof
Video link*
The video link can be uploaded to this application as an HTML, ZIP, MOV or MP3 video. If you uploaded your video above as a file, type N/A.
Application Acknowledgment
I confirm that the responses provided are written in my own voice and reflect my own work.
Signature of Student applicant*

Clear
Should be Empty:

Made for Medicine Student Application

STUDENT INFORMATION

PARENT INFORMATION

EMERGENCY CONTACT INFORMATION

REQUIRED: You must obtain a Teacher Recommendation

REQUIRED: You must upload current academic transcript or grade card

ESSAY QUESTIONS

Video Interview

Application Acknowledgment