HMS MEDscienceTECH Moonshot Foundations Pre-Survey Current Time * (for the purpose of measuring length of survey) Hour Minute Second AM PM Name First Name Last Name Personal Email * Cell Phone Contact Number * Country (###) ### #### ZIP code * HMS MEDscience ID * You can find your ID on your MEDscience lanyard or in the email you received. It should follow this format: HMED-12345. Be sure to include the hyphen in your ID. To maintain anonymity, we ask that everyone participate. If you're a BPS student, please refrain from using your BPS number here. This is an ID number specific to HMS MEDscience. If you are unsure of your specific HMS MEDscience ID, please ask your teacher. Where do you currently attend school? * If you are attending with a program outside of school (i.e., Vertex, BWH, Dana Farber, RBTV), please enter the name of the program. What type of school are you enrolled in during the academic school year? * Boston Public School (BPS) Public School outside of Boston Private School Public charter school 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) Please specify "Other" 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 Please specify "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 Please specify "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) Other language(s) spoken: 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. MEDscience in relation to your career There are no "right" or "wrong" answers! The only correct responses are those that are true FOR YOU. Whenever possible, let the things that you have lived through help you make a choice. 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 What specific career are you interested in pursuing? * 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 In a few words, what do you personally hope to get out of this experience with HMS MEDscienceTECH Moonshot Foundations? * In a few words, what strengths do you possess that will help you when working with your teammates? * Thank you for taking the time to complete this survey.Your input is critical in helping us further enhance the HMS MEDscience experience.
