Become a Participant or Partner School

In the Fall, ElevateMeD hosts a School Information Session for medical school contacts to learn more about partnering with the ElevateMeD Scholars program for the upcoming academic year.

MONDAY, DECEMBER 2, 2024 by 5:00 PM PT

Deadline for school consideration for the 2025-26 Academic Year

You'll need to have the following available:

Department contacts for your school:
*these primary contacts will receive program and scholarship updates from ElevateMeD

Dean of students contact
Financial Aid contact
Public Affairs contact

your school demographics (Breakdown of underrepresented students:
# Black/African-American medical students, # of Hispanic/Latino medical students, # of Native/Indigenous medical students)
your school w-9 (if it has not been submitted before)

Please complete our school survey below for consideration:


School Survey
Medical School *
Does your school have multiple campuses? *	Yes No
If your school has multiple campuses, do they operate as an individual entity or multiple entities?	Single Entity Multiple Entities

School Contacts
These contacts will receive program and scholarship updates from ElevateMeD. Please include: Dean of Students, Financial Aid and a Public Affairs contact.
Primary School Contact
Primary First Name *
Primary Last Name *
Primary Email *
Primary Department *
Primary Job Title *
Primary Phone *
Primary Phone Type *

Secondary School Contact
Secondary First Name *
Secondary Last Name *
Secondary Email *
Secondary Department *
Secondary Job Title *
Secondary Phone *
Alternate School Contact
Alternate First Name
Alternate Last Name
Alternate Email
Alternate Department
Alternate Job Title
Alternate Phone

School Demographics
Communicate medical school student demographics by ethnic background for 2025-26.
# of enrolled medical students *
# of Black/African-American medical students *
# of Hispanic/Latino medical students *
# of Native/Indigenous medical students *
# of Rising M4s *
% of Black/African-American medical students completing medical school in 4 years
% of Hispanic/Latino medical students completing medical school in 4 years
% of Native/Indigenous medical students completing medical school in 4 years

Shared Mission
Increasing Physician Workforce Diversity
Please share in 3-5 sentences, how your school supports underrepresented students in medicine. *
Please share in 3-5 sentences, how your school is currently addressing diversity, equity and inclusion as it relates to student recruitment. *
Please include a list of scholarship opportunities, offered by your institution, for underrepresented students.
Please share the top 5 donors and/or supporters of diversity, equity and inclusion for your institution.
Yes, I would like to receive communications from ElevateMeD by SMS. I agree to receive promotional message sent via autodialer. This agreement isn't a requirement for any purchase or contribution. You may receive 4 msgs/mo. You may opt out at anytime. Reply STOP to end or HELP for help. Terms & Privacy Policy can be found at elevatemed.org/terms. Standard text message rates may apply.
What's the best number for us to text you? *

Upload Your School W-9

Please upload your school's completed and signed W-9.

School Inquiry

Become a Participant or Partner School

MONDAY, DECEMBER 2, 2024 by 5:00 PM PT

Please complete our school survey below for consideration:

School Survey

School Contacts

School Demographics

Shared Mission

Upload Your School W-9

Scottsdale, AZ