Urology Unbound - Find a Doctor

User ID

First name

Last name

Email

Phone

Date of Birth

Current City

Current State

State

Zip Code

Highest Degree Earned

High School

Bachelor's Degree

Master's Degree

Doctoral Degree

Ph.D. or higher

Trade School

Prefer not to say

Other

Highest Degree Earned - Other

Full name of current/most recent school (official name)New field

(Anticipated) Medical School Graduation Year

Please list all professional degrees earned (include concentration, no abbreviations)

Country of Origin

Race (select up to 2 options)

Black or African American

American Indian or Alaska Native

Asian

White

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

Multi-Racial

Ethnicity (select up to 2 options)

African

Caribbean/West Indian

Hispanic/Latinx

Mixed Ethnicity or Race

Other

Ethnicity - Other

Gender Identity

Female

Male

Non-binary

Prefer not to disclose

Prefer to self-describe

Gender Identity Self-Description

Do you consider yourself to be

Straight or heterosexual

Gay, Lesbian or Homosexual

Bisexual

Prefer not to answer

Prefer to self-describe

Sexuality Self-Description

Have you been diagnosed with any disability or impairment?

Yes

No

Prefer not to say

If yes, which of the following have been diagnosed (select all that apply)

A sensory impairment (vision or hearing)

A mobility impairment

A learning disability (e.g., ADHD, dyslexia)

A mental health disorder

A disability or impairment not listed above

Please select the following descriptors you identify with (select all that apply)

First Generation college student

Immigrant

First generation American (US)

Currently the legal guardian and primary caretaker of a minor

DO student

MD student

Grew up poor/lower socioeconomic income

English is your second language

When did you first develop an interest in urology?

Have you participated in or do you plan to participate in a research year?

Yes

No

Maybe

If yes, please list institution, year, and primary investigator.

Does your medical school have a home urology program?

Yes

No

N/A

Do you have any family members or friends in medicine?

Yes

No

Do you have any family members or friends in urology?

Yes

No

What are your primary goals for participation in the R Frank Jones Urology Interest Group? (Please c

Connect with future urology applicants with similar backgrounds/interests to me

Gain advice for navigation of the upcoming application cycle

Increase exposure to urology

Have someone available to review and provide feedback feedback on my application

Increase chances of matching at an RFJUS member's institution/program

General networking

General mentorship

Explore subspecialty interests (endurology, robotics etc)

Other

How did you first hear about the R Frank Jones Urology Interest Group? (short answer)

How did you first develop an interest in urology?

Please provide any feedback or comments you have about this program.

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