Current Time *

(for the purpose of measuring length of survey)

Hour

Minute

Second

AM PM

Name

First Name

Last Name

Cell Phone Contact Number *

Country

(###)

###

####

Where are you in your academic journey? *

NOTE: If you are in the summer program, select the grade that you most recently finished

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

Graduated high school, not in college

First year college

Second year college

Third year college

Fourth year college

Graduated college, not in grad school

Grad school

Medical school

What format are you taking this HMS MEDscience program? *

If you are unsure, please ask your teacher.

Fully In-person

Fully Virtual (e.g. teleMED)

Hybrid (e.g. partly virtual & partly in-person)

What format are you taking this HMS MEDscience program? *

If you are unsure, please ask your teacher.

During the academic school year for the Full Semester (e.g. 7 to 12 sessions during the Fall/Winter/Spring semester)

During the summer for the MEDscience summer program (1 summer week)

During the spring for the MEDscience school break program (1 spring week)

For an Extended Module (2 to 6 at any time during the calendar year)

A Single Module (1 session at any time during the calendar year)

How did you come to participate in HMS MEDscience? *

Through my school, during the academic school year, as part of a necessary requirement (e.g. required class, required extracurricular)

Through my school, during the academic school year, but it is not part of any requirement (e.g. non-required class, non-required extracurricular)

Outside of school (e.g. fun, curiosity, friends)

Other (please type below)

Have you participated in any number of HMS MEDscience sessions before? (Select all that apply) *

No, this is my first time

Yes, I participated in the HMS MEDscience program

Yes, I participated in the HMS MEDscienceLAB program

Yes, I participated in the HMS MEDscienceLAB Forensics program

Yes, I participated in the HMS MEDscience Moonshot Foundations program

Yes, I participated in the HMS MEDscience Moonshot Visionaries program

Yes, I participated in the HMS MEDscience Dental program

Which best describes you? *

Female

Male

Intersex

Prefer not to say

Which best describes you? *

Cisgender (gender identity corresponds with the sex registered at birth)

Transgender

Non-Binary

Prefer not to say

What pronouns do you use? *

She/her/hers

He/him/his

They/them/their

Prefer not to say

Other

What best describes you? *

Hispanic or Latino includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin.

Hispanic or Latino

Not Hispanic or Latino

Select all that apply: *

For reference: - American Indian or Alaska Native (Individuals with origins in any of the original peoples of North, Central, and South America, including, but limited to, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya) - Asian (Individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia, including, but limited to, for example, Cambodian, Chinese, Indian, Filipino, Vietnamese, Malaysian, Pakistani, Thai, Korean, and Japanese.) - Black or African American (Individuals with origins in any of the Black racial groups of Africa, including, but limited to, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali.) - Middle eastern or North African (Individuals with origins in any of the original peoples of the Middle East or North Africa, including, but limited to, for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli.) - Native Hawaiian or Pacific Islander (Individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including, but limited to, for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese.) - White (Individuals with origins in any of the original peoples of Europe, including, but limited to, for example, English, German, Irish, Italian, Polish, and Scottish.)

American Indian or Alaska Native

Asian

Black or African American

Middle eastern or North African

Native Hawaiian or Pacific Islander

White

Other

What languages do you speak (check all that apply) *

Arabic

English

German

French

Haitian Creole

Hindi

Cape Verdean Creole

Korean

Mandarin

Cantonese

Portuguese

Spanish

Vietnamese

Not listed here (please type below)

How comfortable are you with the English language? *

Entirely fluent (native/bilingual): speaks, writes, and reads at the level of an educated native speaker, with natural pronunciation, intonation, and a deep understanding of cultural and contextual nuances

Advanced proficiency: can speak fluently and spontaneously on a wide range of subjects. Uses complex sentence structures and idiomatic expressions, with only occasional minor errors. Can write with a strong grasp of grammer and vocabulary.

Intermediate proficiency: Can engage in everyday conversations on familiar topics. May have some hesitation and make grammatical errors, but can generally be understood by native speakers.

Elementary proficiency: can read, understand and communicate using simple phrases and sentences. Relies heavily on memorized expressions and may struggle with pronunciation and spontaneous conversation.

No proficiency: the English language is complete foreign.

Do you plan to complete your current education? *

Yes

No

Do you plan to complete higher education (e.g. college, graduate school)? *

Yes

No

How likely are you to pursue a career in medicine or STEM? *

Highly unlikely

Unlikely

Likely

Highly Likely

Do you have a family member in the career you are interested in pursuing? *

Yes

No

Do you have a mentor in the career you are interested in pursuing? *

Yes

No

Are you aware of the steps needed to pursue your career of interest? (e.g. have you done your research?) *

Yes

No