Atlantis Fellowship Application 1 Basic Information2 Academics3 Short Responses and Additional Questions Which country are you most interested in?*UndecidedSpainItalyGreecePortugalHungaryCroatiaSerbiaWorld Traveler FellowshipMCAT FellowshipWhich city are you interested in?*UndecidedCalatayudFerrolMallorcaMéridaOurenseWhich city are you interested in?*UndecidedBergamoBolognaMantuaMilanPaduaPaviaRomeTrentoTurinWhich city are you interested in?*UndecidedAthensWhich city are you interested in?*UndecidedLeiriaLisbonMatosinhosWhich city are you interested in?*UndecidedBudapestWhich city are you interested in?*UndecidedZagrebWhich city are you interested in?UndecidedBelgradeHow strongly would you rate your preference for this location?*Select...LOW (I am really open to going almost anywhere in Europe)MEDIUM (I want to go to this program country but I am open to discussing other options)HIGH! (If I do not receive a placement in this country I will likely not do Atlantis)Are there any dates this summer when you cannot do an Atlantis program?*YesNo(Family vacation, etc.)What dates do you have plans?*(Ex: Family Vacation - July 20th-28th)Name* First Last Primary Email Address* Please be sure you are checking the Primary Email Address regularly. This is how we will contact you.Phone Number*Time Zone*Eastern TimeCentral TimeMountain TimePacific TimeOtherWhat is your time zone?*Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*MaleFemaleOtherPermanent Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Parent Contact Name* First Last Parent Contact Email* I agree to allow Atlantis to notify my listed parent/guardian if I am accepted as an Atlantis Fellow.YesNoHave you ever traveled to a country where you do not speak the native language?*YesNoDo you speak any other languages fluently in addition to English?*YesNoWhat languages do you speak?*What did you see or hear that convinced you to apply to the Atlantis Fellowship?*Select...Facebook or InstagramPoster or FlyerGoogle or Online SearchAtlantis AmbassadorSchool Pre-med or Health AdviserCampus Pre-med ClubFriend or Atlantis AlumniStudy Abroad SiteSnapchatCampus or Club Fair/ConferenceHandshakeOtherPlease Specify*Please enter the full name of the person or organization that referred you*Have you ever met or talked to an Atlantis alumni or ambassador?*YesNoWhat was their name?*If you don't recall, please write "can't recall"Would you like us to connect you via email with an alumni or ambassador from your school?*YesNo Save Application College/University*Type to search...Abilene Christian UniversityAcadia UniversityAdelphi UniversityAdrian CollegeAdventist University of Health SciencesAgnes Scott CollegeAlabama Agrcltl & Mechl UnivAlabama State UniversityAlbany State UniversityAlbion CollegeAlbright CollegeAlcorn State UniversityAllegheny CollegeAlma CollegeAlvernia UniversityAmerican International CollegeAmerican River CollegeAmerican UniversityAmerican University of BeirutAmherst CollegeAnderson University (SC)Anderson University IndianaAndrews UniversityAngelo State UniversityAnna Maria CollegeAntelope Valley CollegeAppalachian State UniversityArizona State UniversityArkansas State UniversityArkansas Tech UniversityAssumption CollegeAuburn UniversityAugusta UniversityAugustana CollegeAurora UniversityAustin CollegeAustin Community CollegeAustin Peay State UniversityAzusa Pacific UniversityBakersfield CollegeBall State UniversityBarnard CollegeBarry UniversityBarton CollegeBaruch College CUNYBates CollegeBay Path CollegeBaylor UniversityBellarmine UniversityBellevue CollegeBelmont Abbey CollegeBeloit CollegeBenedict CollegeBenedictine UniversityBennett College for WomenBerea CollegeBergen Community CollegeBerry CollegeBethel UniversityBethune Cookman UniversityBinghamton UniversityBinghamton University SUNYBiola UniversityBirmingham Southern CollegeBlinn CollegeBloomburg University of PABluefield CollegeBob Jones UniversityBoise State UniversityBoston CollegeBoston UniversityBowdoin CollegeBowie State UniversityBowling Green State UniversityBradley UniversityBrandeis UniversityBrevard 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SUNYCollege of AlamedaCollege of CharlestonCollege of DuPageCollege of IdahoCollege of Mount Saint VincentCollege of New JerseyCollege of Saint Benedict/Saint John's UniversityCollege of Saint ElizabethCollege of Saint RoseCollege of Saint ScholasticaCollege of San MateoCollege of Southern IdahoCollege of Southern NevadaCollege of The Holy CrossCollege of William and MaryCollege of WoosterColorado CollegeColorado Mesa UniversityColorado State UniversityColumbia College in South CarolinaColumbia UniversityColumbus State UniversityCommunity Collefe of Allegheny CountyCommunity College of Baltimore CountyCommunity College of PhiladelphiaConcordia CollegeConcordia University PortlandConnecticut CollegeConverse CollegeCoppin State UniversityCorban UniversityCornell CollegeCornell UniversityCreighton UniversityCumberland County CollegeCUNY Borough of Manhattan Community CollegeCUNY Bronx Community CollegeCUNY Brooklyn CollegeCUNY Hostos Community CollegeCUNY John Jay CLG Criminal JusticeCUNY 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Austin State UniversityStetson UniversityStevens Institute of TechnologyStevenson UniversityStonehill CollegeStony Brook University SUNYStrayer UniversitySuffolk County Community CollegeSuffolk UniversitySUNY College Old WestburySUNY CortlandSUNY FredoniaSUNY GeneseoSUNY New PaltzSUNY OneontaSUNY OswegoSUNY PlattsburghSUNY Polytechnic InstituteSUNY PotsdamSusquehanna UniversitySwarthmore CollegeSyracuse UniversityTaft CollegeTarleton State UniversityTarrant County CollegeTaylor UniversityTemple UniversityTennessee State UniversityTennessee Technological UniversityTexas A&M TexarkanaTexas A&M UniversityTexas A&M University CommerceTexas A&M University Corpus ChristiTexas A&M University KingsvilleTexas Christian UniversityTexas Southern UniversityTexas State UniversityTexas Tech UniversityTexas Woman's UniversityThe CitadelThomas Jefferson UniversityTougaloo CollegeTowson UniversityTransylvania UniversityTrevecca Nazarene UniversityTrinity CollegeTrinity UniversityTroy UniversityTruman 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MayaguezUniversity of Puerto Rico PonceUniversity of Puerto Rico Recinto Rio PiedrasUniversity of Puget SoundUniversity of RedlandsUniversity of Rhode IslandUniversity of RichmondUniversity of RochesterUniversity of Saint Francis Fort Wayne IndianaUniversity of Saint JosephUniversity of San DiegoUniversity of San FranciscoUniversity of SaskatchewanUniversity of Science and Arts of OklahomaUniversity of ScrantonUniversity of Sioux FallsUniversity of South AlabamaUniversity of South CarolinaUniversity of South Carolina BeaufortUniversity of South DakotaUniversity of South FloridaUniversity of Southern CaliforniaUniversity of Southern IndianaUniversity of Southern MississippiUniversity of St Thomas St Paul MinnesotaUniversity of TampaUniversity of Tennessee ChattanoogaUniversity of Tennessee KnoxvilleUniversity of Texas ArlingtonUniversity of Texas AustinUniversity of Texas DallasUniversity of Texas El PasoUniversity of Texas of the Permian BasinUniversity of Texas Pan AmericanUniversity of Texas Rio Grande ValleyUniversity of Texas San AntonioUniversity of Texas TylerUniversity of the CumberlandsUniversity of the Incarnate WordUniversity of the PacificUniversity of the Sacred HeartUniversity of the SciencesUniversity of ToledoUniversity of TorontoUniversity of TulsaUniversity of UtahUniversity of VermontUniversity of VictoriaUniversity of VirginiaUniversity of WashingtonUniversity of WaterlooUniversity of West FloridaUniversity of West GeorgiaUniversity of Western OntarioUniversity of WindsorUniversity of WinnipegUniversity of Wisconsin Eau ClaireUniversity of Wisconsin Green BayUniversity of Wisconsin La CrosseUniversity of Wisconsin MadisonUniversity of Wisconsin MilwaukeeUniversity of Wisconsin OshkoshUniversity of Wisconsin ParksideUniversity of Wisconsin River FallsUniversity of Wisconsin StoutUniversity of Wisconsin WhitewaterUniversity of WyomingUrsinus CollegeUtah State UniversityUtah Valley UniversityUtica CollegeValdosta State UniversityValencia Community CollegeValparaiso UniversityVancouver Island UniversityVanderbilt UniversityVassar CollegeVentura County Community College DistrictVillanova UniversityVincennes UniversityVirginia Commonwealth UniversityVirginia Military InstituteVirginia State UniversityVirginia Tech UniversityVirginia Union UniversityVirginia Wesleyan CollegeWagner CollegeWake Forest UniversityWalla Walla UniversityWalsh UniversityWarren Wilson CollegeWartburg CollegeWashburn UniversityWashington Adventist UniversityWashington and Jefferson CollegeWashington and Lee UniversityWashington CollegeWashington State UniversityWashington State University VancouverWashington University in St. LouisWayland Baptist UniversityWayne State UniversityWeber State UniversityWebster UniversityWellesley CollegeWesley CollegeWesleyan UniversityWest Chester UniversityWest Virginia UniversityWestchester Community CollegeWestern Carolina UniversityWestern Connecticut State UniversityWestern Kentucky UniversityWestern Michigan UniversityWestern State Colorado UniversityWestern Washington UniversityWestfield State UniversityWestminster College Salt Lake CityWestmont CollegeWharton County Junior CollegeWheaton CollegeWheaton College MAWheeling Jesuit UniversityWhittier CollegeWhitworth UniversityWichita State UniversityWilfrid Laurier UniversityWillamette UniversityWilliam Paterson UniversityWilliams CollegeWilmington UniversityWingate UniversityWinston Salem State UniversityWinthrop UniversityWisconsin Lutheran CollegeWittenberg UniversityWofford CollegeWorcester Polytechnic InstituteWorcester State UniversityWright State UniversityXavier UniversityXavier University of LouisianaYale UniversityYork CollegeYork College of PennsylvaniaYork UniversityYoungstown State UniversityOtherIf your university is not listed, choose "Other" and you will be prompted to manually enter your university.Please enter the name of your school*Expected Graduation Year*Select...2019202020212022GraduatedCurrent Year in School*FreshmanSophomoreJuniorSeniorOtherMajor/Area of Study*University GPA*What health-care career are you planning on pursuing?*Select...MD/DOPANursingPhysical TherapyPharmacyOtherUnsurePlease explain your career of interest*Have you taken the MCAT?*Select...YesNo, but scheduled to take itNoWould you be interested in our combined MCAT Prep and shadowing program this summer?*YesNoAre you a member of AMSA?*YesNo Save Application Almost there!Just a few more questions and you'll be finished up.Personal Statement and Short AnswersPlease compose a Personal Statement answering the question: Why are you pursuing a career in medicine and what are your long-term goals in healthcare? [minimum 200 words]*Please briefly list any leadership roles, activities and groups that you have or are currently participating in (e.g. pre-med club, sororities/fraternities, volunteer experience, etc). Choose any one experience in these roles or in healthcare specifically and discuss what you learned from that experience.*How does shadowing abroad with the Atlantis Fellowship align with your long-term goals? [minimum 200 words]*Please list any additional questions that you have about the Atlantis Fellowship.Reference (Optional)*If your GPA is below 3.0, it is highly encouraged that you provide at least one academic reference such as a past professor, or a professional reference such as a recent employer or supervisor. References may be contacted via email to submit a short online form, and will not be required to send a letter of recommendation.Reference Name First Last Reference Email Reference Phone NumberReference Relationship to youWhy you applied and additional questionsPlease reflect for a few sentences on when and how you first heard about Atlantis and why you eventually decided it was worth applying. Highlight anything that was memorable - an ad you saw, a conversation with an alum, a page on our website, etc..*What are you considering this summer in addition to Atlantis? (select all that apply)* Working to earn money Summer classes Other healthcare-focused internships or research Other shadowing opportunities in the United States Other global programs Right now, Atlantis is the only thing I am considering If you are accepted for an Atlantis Fellowship placement, who will be responsible for paying associated program fees?*Select...I will pay for 100% of the program feesI will pay for part and my parents will pay for partI will need my parents to cover 100% of the program feesOtherPlease explain how you plan to fund your Atlantis Fellowship*If Atlantis offered a multi-year global health program, where you traveled to different countries each summer and progressively learned more and more about global medicine, would you be interested?*Select...Yes, absolutely!Yes, but I am not sure I can afford multiple programs.No, I am only planning to go abroad once.Did you complete this application in one sitting?*YesNo Save Application This iframe contains the logic required to handle Ajax powered Gravity Forms.