MISA Program Application

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Application Selection

Which program are you applying for?

Which MISA Spring cohort(s) you'd like to participate in:

A: March 31st-April 4th, 2025B: April 7th-11th, 2025C: April 21st-25th, 2025No preference

Medical Immersion Scholars Academy

Thank you for your interest in the 2025 Medical Immersion Scholars Academy! Please complete the following application in its entirety and submit the $75 non-refundable application fee. Only complete and paid applications will be considered.

Application Deadline: Monday, January 13th, 2025 by 11:59pm PST.

Program Cost: $1,800

Program Dates: Cohort A: March 31st-April 4th, 2025

Cohort B: April 7th-11th, 2025

Cohort C: April 21st-25th, 2025

Program Hours: 9:00AM-3PM

Applicant Requirements

Interest in pursuing a healthcare career
Current 9-12th grade high school student
$75 non-refundable application fee

Interviewing for MISA

Submitting an application does not guarantee an interview. Interview notifications will be sent on Monday, January 27th and will take place in person for local applicants or via Zoom video conference for out of state applicants Saturday, February 8th.

Important Dates

Application deadline: January 13th, 2025
Interview notifications (sent via email): January 27th, 2025
Interviews: February 8th, 2025
Spring Admissions Released: February 17th, 2025

Currently our plan is to offer all 2025 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:

Please provide the first and last name of the previous MISA participate who reffered you

AGREEMENT & SIGNATURE

I have read and understand the information about the Medical Immersion Scholars 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

Code

Billing Address

Billing Street Address

Billing Address Line 2

Billing State/ Province/ Region

Billing City

Billing Postal/Zip Code

Billing Country

Billing Email

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