MISA Program Application

Application Selection

Which program are you applying for?

Which MISA cohort you'd like to participate in:

Medical Immersion Spring Academy

Thank you for your interest in the 2024 Medical Immersion Spring Academy! Please complete the following application in its entirety and submit the $50 non-refundable application fee. Only complete and paid applications will be considered.

Application Deadline: Saturday, January 6th, 2024 by 11:59pm PST.

Program Cost: $1,400

Program Dates: Cohort A: March 25th-29th, 2024

Cohort B: April 1st-5th, 2024

Cohort C: April 8th-12th, 2024

Program Hours: 9:00AM-3:30PM

Applicant Requirements

Interest in pursuing a healthcare career
Minimum age 15 by program start date or completion of freshman year
$50 non-refundable application fee

Interviewing for MISA

Submitting an application does not guarantee an interview. Interview notifications will be sent on Friday, January 26th and will take place in person for local applicants or via Zoom video conference for out of state applicants Saturday, February 10th.

Important Dates

Application deadline: January 6th, 2024
Interview notifications (sent via email): January 26th, 2024
Interviews: February 10th, 2024
Spring Admissions Released: February 16th, 2024

Currently our plan is to offer all 2024 programming in-person and follow all public health precautions to prevent the spread of COVID-19 and ensure participant safety. Participants will have to provide proof of full COVID-19 vaccination for MISA.

Late/incomplete applications will NOT be accepted. For more information, visit our website: misahealth.com. If you have any questions about the MISA program or this application, please contact us via email at misa@mimscience.org. Thank you.

Medical Immersion Summer Academy

Thank you for your interest in the 2023 Medical Immersion Summer Academy! Please complete the following application in its entirety and submit a $50 non-refundable application fee. Only complete and paid applications will be considered.

Application Deadline: Friday, March 17th, 2022 by 11:59pm PST.

Program Cost: $1,400

Participants Can Apply to Participate in the Following Program Dates:

Cohort A (July 10th-14th)
Cohort B (July 17th-21st)
Cohort C (July 24th-28th)
Cohort D (July 31st- August 4th)

Program Hours: 9:00-3:00 pm

Applicant Requirements

Interest in pursuing a healthcare career
Minimum age 15 by program start date or completion of freshman year
$50 non-refundable application fee

Interviewing for MISA

Submitting an application does not guarantee an interview. Interview notifications will be sent on Friday, April 7th and will take place via Zoom video call beginning April 19th through April 30th, 2023.

Important Dates

Application deadline: March 17th, 2023
Interview notifications: Friday, April 7th, 2023
Interviews: April 19th-30th, 2023
Summer Admissions Released: May 5th, 2023

Currently our plan is to offer all 2023 programming in-person and follow all public health precautions to prevent the spread of COVID-19 and ensure participant safety. Participants will have to provide proof of full COVID-19 vaccination for MISA.

Late/incomplete applications will NOT be accepted. For more information, visit our website: misahealth.com. If you have any questions about the MISA program or this application, please contact us via email at misa@mimscience.org. Thank you.

Personal Information

Name

First

Last

Address

Street Address

Address Line 2

State/ Province/ Region

City

Postal/Zip Code

Country

Mobile Phone Number

Can we text you?

Permanent Email (please do not use your school email)

Date of Birth

Gender

Please self-identify here:

Race/Ethnicity?

Please specify your race/ethnicity:

Select the primary language you speak at home (if it is a language other than English).

Name of language(s) if not listed:

Parent/ Guardian Information

Parent/ Guardian Name

First

Last

Parent/Guardian Phone Number

Parent/Guardian Email

Relationship to you:

EDUCATIONAL BACKGROUND

Please answer the following questions about your education level and current high school.

Name of School:

Current grade in school:

Overall Grade Point average (4.0 Scale)

Are there any other commitments you have during your preferred program week? Include work, school, other internships, research, etc., (Word Count Max: 100)

SHORT ANSWER INSTRUCTIONS

Please answer the short answer prompts below. Make sure you fully address all parts of the prompt. (Max 250 words)

What is your health career goal and what experiences have shaped that goal? Please include specific examples from your academic successes, challenges and personal experiences.

How will this internship experience help move you towards your goal?

What activities or pursuits in your life energize you the most? What makes you feel alive and enthusiastic?

How did you find out about the MISA program?

Please specify:

AGREEMENT & SIGNATURE

I have read and understand the information about the Medical Immersion Summer Academy. By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a participant, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal without refund. I understand that my application is not complete without BOTH my signature and my parent/guardian’s signature. I am not signing for my parent/guardian.

I agree

Participant Electronic Signature

Name

Date

Permanent Email (please do not use your school email)

Parent/Guardian Electronic Signature

Name

Date

Application Fee Payment Information

Reminder: Your card will be charged a non-refundable $50

Payment Information

Name on Card

Card Number

MM

YY

Code

Billing Address

Billing Street Address

Billing Address Line 2

Billing State/ Province/ Region

Billing City

Billing Postal/Zip Code

Billing Country

Billing Email