Summer Surgery Program Student Application

Testimonials
Personal/Contact Information
Male
Female
XS
S
M
L
XL
XXL
S
M
L
L
XL
XXL
XS
S
M
L
L
XL
XXL
American Indian/Alaskan Native
Hispanic/Latino
American Asian
Native Hawaiian/Pacific Islander
Asian
Other (Please specify below)
Black
Decline to state
Caucasian/White

Students must be 16 years old before the start of the program in order to participate.

Please choose your first priority for session scheduling:

Session I: July 10th - July 21st
Session II: July 24th - August 4th
I am available to participate in any session
High School Information
Emergency Contact Information
Are either of your parents an employee of the University of California? Yes No

Personal Responses

These short essays will help to give us some insight to your personality and interests. Please attach your short essay answers on a separate page at the end of this application.

1. Please describe why you would like to participate in the UC Irvine Heath Summer Surgery Program. (please remember these are “short” essay questions)

2. Please list the top 5 most important activities, hobbies, or special experiences you’ve had.

3. Choose your favorite/most important of the above activities and describe what you have gained from this experience and how you have or will use this to make an impact on others.

By typing my name below, I certify that all the information provided in this application is correct:

Nothing but the absolute best in patient care & treatment.

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