Become a Partner School

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

Please complete our inquiry form below and upload your school W-9 for consideration.

5:00PM FRIday, October 18, 2024

Deadline for school consideration for the 2025-26 Academic Year

You'll need to have the following available:

a primary & secondary contact for your school of medicine
your school demographics (Breakdown of underrepresented students:
# Black/African-American medical students, # of Latinx medical students, # of Native/Indigenous medical students)
your school w-9

partner school inquiry form:


Partner School Inquiry
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
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 *

School Demographics
Communicate medical school student demographics by ethnic background
Class Size: # of Rising M3s *
Class Size: # of Rising M4s *
# of Black/African-American medical students *
# of Latinx medical students *
# of Native/Indigenous medical students *

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.

Upload Your School W-9

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

Partner School Inquiry

Become a Partner School

5:00PM FRIday, October 18, 2024

partner school inquiry form:

Partner School Inquiry

School Contacts

School Demographics

Increasing Physician Workforce Diversity

Upload Your School W-9

Scottsdale, AZ