PAC Little Sibling Questionnaire

Instructions

  1. Please fill out and return the survey below to
  2. Please send in a digitalphoto (or scanned file) of yourself so that we can put together the COM 2010 facebook and the DPT 2009 facebook which will be posted online.

This survey will be used to match you with a member of the COM class of 2009 and the DPT class of 2008. Your big sibling will give you advice, support, and maybe even a few textbooks to help you get through your first year of medical school.

RETURN THIS SURVEY BY E-MAIL () ASAP!

(Do not forget to attach your picture)

DEADLINE JULY 14, 2006

PAC Little Sibling Questionnaire

Name:

Nickname:

Gender:

Address:

Phone number(s):

Email address:

Birthday:

Place of birth:

Hometown:

High school(s) attended:

Other cities you have lived in:

Religion (optional):

Other languages you speak:

Marital status/Engaged/Relationship/Single:

Children or pets:

Siblings:

Military affiliation:

Undergraduate college:

Major(s)/minor(s):

Graduate degree(s):

Past occupations/volunteer work:

In what specialties of medicine are you interested?

Indicate all the activities that you plan to participate in during your first year of medical school (put an X)

-Intramural Sports

-Membership in Interest Groups/Organizations

-Leadership in Interest Groups/Organizations

-Consistent Exercise Program/Classes

-Class Social Events

-Student Government

-Volunteer Opportunities (Health Fairs, JC Clinic, Project World Health, etc.)

-Professional Sporting events (Bucs, Lightning, Devil Rays)

-College (USF, FSU, UF, UCF, U Miami, etc) sporting events

-Patroning the Arts (Concerts, Museums, Plays)

-Extracurricular reading (medically related or not)

-Practice of a Musical Instrument

-Research Opportunities

-Other: (Please fill in)

PAC Little Sibling Questionnaire

1. What type of student are you?

  1. slacker
  2. ‘good enough’ to get by
  3. work hard / play hard
  4. ‘gunner’ / overachiever
  5. ‘I will sleep in the cadaver lab’ to be #1

2. In Undergrad did you:

a. Go to every class and see the professor during office hours

b. Go to most all classes

c. Skip every other class or so

d. Attend just for the test

3. Friends would most describe you as:

a. hardworking/dedicated

b. outgoing/energetic

c. introspective/quiet

d. laidback/ carefree

4. For fun, on the weekends or after a test you’ll find me

  1. a dance club
  2. a bar
  3. relaxing with close friends or family
  4. home by myself
  5. at the library studying for the next exam

5. What part of Tampa do you live in/are you thinking of living in?

a. New Tampa

b. Right around campus

c. South Tampa

d. St. Petersburg/Clearwater

e. Brandon

f. Other: ______

6. What is your most used informal mode of communication?

a. Talking on the phone

b. Text messaging

c. AIM

d. Email

e. Talking in person

f. Message boards

7. Which would you prefer to drink on a long weekend?

a. O.J.

b. Beer

c. Soda

d. Mixed drink

8. What’s your favorite type of music?

9. If you could have one superpower what would it be?

10. What hidden talent do you have that no one knows about?

11. What’s your favorite/dream vacation?

12. Favorite Quote:

Can we share the information on this survey with your Big Sibling?

If you are in the COM Class of 2010 do you know anyone in the Class of 2009?

If you are in the DPT Class of 2009 do you know anyone in the Class of 2008?

If you would like them to be your Big Sibling (or anyone not to be your Big Sibling), please, list their name:

*Please add any information about yourself that you think would help us in matching you with a compatible Big Sibling: