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Become a HCRPI-M Scholar
Become a HCRPI-M Scholar
Interested in Becoming a HCRPI-M Scholar
Fill out the form below, and a NC-HCAP Team Member will follow up with more information.
Name
First
Last
Email
Phone Number
Race/Ethnicity
Black or African American
Native American or American Indian
Hispanic or Latino
Other
If you selected other, please comment below.
Classification
Freshman
Sophomore
Junior
Senior
Major
Minor (If Applicable)
Interest
Health Professions
Research
Career Interest
T-Shirt Size
Small
Medium
Large
X-Large
XX-Large
The first cohort meeting will be held on Friday November 9th, 2018 at 4:00pm. Are you able to attend?
Yes
No
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