The Apprentice Academy – Immersion in Medicine 2023/2024 – Application

Kindly complete all fields and submit:

Name*
First Last
Given and Family Names of Applicant (Student)
Age:*
Age as on January 1, 2024
Gender
- Male
- Female
Choose a program:*
- Medical Foundational Skills (SOLD OUT)
- Immersion in Medicine Skills Course Cluster
Kindly choose a program
Academic level*
- Grade 9
- Grade 10
- Grade 11
- Grade 12
- Premed 1
- Premed 2
- Premed 3
- Premed 4
- Other
Please enter your Academic Status - as in August 2023
Scrubs size*
- XS
- S
- M
- L
- XL
- XXL
Kindly let us have the size of scrubs that you wear (if unsure - rather choose slightly bigger).
Email address student:*

The student's email address
Email address parent:

Email address of one of the parent/s or guardian.
Student's cell phone number:*
We will not use this for marketing purposes.
Parent's phone number:
A reliable contact number of a parent/guardian.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
This should be a physical delivery address, please
Academic institution:*
School/college/university/homeschool/other
Email address academic institution:*

Email address academic institution
Application letter (required)*
Write a short application letter to Dr. Anton Scheepers (with information about yourself (academics, achievements, etc.), your goals and dreams. (Maximum 2500 characters.) (Once finished, click "Submit" once only.)
Email
This field is for validation purposes and should be left unchanged.

1100 Military Rd Buffalo, NY 14217