2027 White Coat Week Program
Please complete this form in its entirety by January 18, 2027 to apply for the Future of Medicine Summer Program. Completion of this form does not guarantee acceptance into the program. Students will be notified of acceptance on February 8, 2027 via email provided in this application. For questions, contact Sam Mello-Edwards at SMello@ssvms.org.
Name
*
First Name
Last Name
Student Email (Please use a PERSONAL email and not a school email)
*
example@example.com
Student Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home zip code
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
High School Attending
*
School District
*
Current High School GPA
*
Current Grade
*
Sophomore
Junior
Senior
College Student
Other
Have you attended Future of Medicine in the past?
*
Yes, in-person spring program
Yes, in-person summer program
Yes, virtual summer program
No
Which week are you applying for? (please select the week that corresponds with your spring break week) Note: due to limited volunteer availability, not all spring break weeks can be accommodated).
*
Week 1 (March 22-March 25, 2027)
Week 2 (April 5-April 8, 2027)
I can attend either week
Parent/Guardian/Emergency Contact Name
*
First Name
Last Name
Parent/Guardian/Emergency Contact Email
*
example@example.com
Parent/Guardian/Emergency Contact Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Short Answer/Interview Questions
This page will ask you to short interview questions to learn more about you and your achievements and goals. Imagine that Physicians were interviewing you about your interest in participating in the program; how would you answer them?
Was there a class, experience, person, event, or question that made you interested in healthcare? Tell us about it.
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0/500
What opportunities have you had—or not had—to explore healthcare careers? How would participating in this program make a difference for you?
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0/500
What is something you regularly do to help your family, school, workplace, or community? What have you learned from doing it?
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0/500
Describe a time when something did not go as planned. How did you respond?
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0/500
If you could improve one thing about health or wellness in your community, what would you choose and why?
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0/500
Healthcare professionals meet people from many different backgrounds and experiences. What do you think is important when working with someone whose life is different from your own?
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0/500
What is a strength you would bring to this program that might not be obvious from your grades or activities?
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0/500
What does professionalism mean to you, and how would you demonstrate it while participating in a medical shadowing program?
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0/500
Imagine you complete the program and discover that a healthcare career is different from what you expected. How could that still be a valuable experience?
*
0/500
Is there anything else you would like to share with us?
*
0/500
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Final Acknowledgement
Please complete upload final documents and acknowledgements prior to submitting your applications. Note: Once submitted, applications can not be changed.
Please upload a current high school transcript
*
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Please upload a letter of recommendation from one teacher or employer. *If your school requires the letter be sent directly to us, have them email the letter to Sam Mello at SMello@ssvms.org.
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How did you hear about this program?
*
My school/teacher/counselor
Fellow student/friend
Career fair/public event
Google/online search
Other
*
I understand that submitting this application does not guarantee acceptance into the program.
By submitting this application, I am committing to attend all sessions of the program if accepted.
If accepted, I will contact my doctor immediately to obtain vaccination records showing current MMR, Varicella, and Tdap vaccines, and obtain a QuantiFERON blood TB test. Vaccine requirements subject to change per health system requirements.
I have provided or will provide one letter of recommendation from a teacher or employer.
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