Thank you for your interest in obtaining a Family Medicine field specific advisor! We are excited to meet with you, learn about you, and help you achieve your goals.
In order to best match you with an advisor, and get you the best advice, we need some basic information from you.
Please complete the online form below. Once you do that, someone from the Department of Family Medicine will get in touch with you as soon as possible.
If you have any questions, feel free to contact: Florence Laforest, Manager of Student Relations in the Department of Family Medicine, at firstname.lastname@example.org or (617) 414-6237; or Miriam Hoffman-Kleiner, Director of Medical Student Education in the Department of Family Medicine, at email@example.com or
617-414-6208; or Joanne Wilkinson, Assistant Professor in the Department of Family Medicine at firstname.lastname@example.org or 617-414-6198.
Expected year of graduation
(i.e., Class of ____)
Where are you from originally?
Please indicate your degree of certainty that you will apply in family medicine (from 0% to 100%)
If you are sure you are going into FM, at what point did you decide that?
before medical school
I have not decided yet
Were you in FaMeS?
In what year of medical school did you enroll in FaMeS?
Did you do the FM Summer Externship?
Are you planning to concurrently apply in any other specialty?
If you will take longer than 4 years to graduate, please indicate the reason here:
What part or parts of the country are you interested in for residency (if you know)?
Are you planning any away electives during 4th year?
If so, when and where?
Please indicate if you have had any academic difficulties (failed boards, had to repeat courses or clerkships, or required extra time to complete graduation requirements). This helps us plan better how to counsel you.
Have you already spoken with a FM faculty about being your FSA?
If yes, whom:
Do you have a request for a specific FM faculty?
If yes, who?
(We will do our best to accommodate requests, but cannot guarantee all will be met. You are also encouraged and allowed to meet with FM faculty who are not your FSA)
Is there anything else you would like to let us know at this point?