Overall Program - Hopkins Medicine Youth/Undergraduate and Summer Opportunities Registration

Instructions

Johns Hopkins University School of Medicine's (JHUSOM) Office of Student Pipeline Programs oversees the registration, approval process, and verification of required documents in order for youth/undergraduates to receive a JHUSOM ID badge during the academic year and for any summer program.

Each program is required to complete this registration form (one for each program even if a program only has a single participant in a lab). This should be completed by the director or administrator of the program. The goal is to get an overview of the overall program, its purpose, and number of participants. At the end of the summer, we plan to produce a directory of programs as a reference for next year. Completion of the form is required as part of the process to receive a Hopkins ID.

If you have any questions, please email SOMYouthPrograms@jhmi.edu.

* Required

Program Information

Please don’t use acronyms and spell out the entire program name.
If you have a website that provides this information, please provide it below instead of rewriting the description)
This person should be the point person in case the Office for Student Pipeline Programs has any questions about the program or has an emergency in which we need to locate your participant or contact their parent/guardian.
Insert mailing address and any additional directions on how to find the office that oversees the program.
First day participants are expected to be at the School of Medicine or Hospital.
Last day participants are expected to be at the School of Medicine or Hospital.

Information About Participants/Students

Different paperwork is required for participants/students who are 14 to 17 years old and those that are 18 years old and older. Additional training and documents may be required depending on what your participants/students will be doing while in the program. Please respond to the prompts below.

Please use numbers only.
Please use numbers only.
Will any of your participants/students be working with any of the following? (Select all that apply) *
Additional training and documentation may be required if any of your participants/students are working with any of the following. Training will be the responsibility of the individual programs.
(in person, on the phone, or in a location frequented by patients)
(work directly with them or in an area in which they will have access)