Pre-Med Mentor Application

We accept students into the pre-med mentoring program between May 1st and September 15th of each year.

PRE-MED STUDENT PROGRAM FRAMEWORK

The CPL pre-med mentoring program provides resources through the learning platform, yearly conference and interaction with CPL member medical students.

Full Name *

Prefix First Name Last Name

Please read: Canadian Physicians for Life Statement of Principles *

I agree with Canadian Physicians for Life’s Statement of Principles. *CPL members donate funds to facilitate the mentoring of pre-med students. I am not in agreement with Canadian Physicians for Life’s Statement of Principles.

University Currently Attending

Grad Year

Sex *

Male Female

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

E-mail *

How did you hear about CPL’s Pre-Med Mentoring Program? *

What are you hoping to gain from the pre-med mentoring program?