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Information Form for SMD’24 Students

Information Form for SMD’24 Students

The information gathered from this form will be used to help the UVA Medical Alumni Association plan the White Coat Ceremony and Family Day, as well as to keep your family members updated on School of Medicine news. ** Please complete form by September 4, 2020. Thank you. **

  • STUDENT INFORMATION

  • If your name could be pronounced more than one way, please complete this section with your preferred pronunciation.
  • If your name could be pronounced more than one way, please complete this section with your preferred pronunciation.
  • UVA INFORMATION

  • FAMILY INFORMATION

    Please enter contact information for parents, guardians and spouses only
  • Family Member 1

  • Please include any suffixes (Jr., III, MD, etc.)
  • Family Member 2

  • Please include any suffixes (Jr., III, MD, etc.)
  • Family Member 3

  • Please include any suffixes (Jr., III, MD, etc.)
  • Family Member 4

  • Please include any suffixes (Jr., III, MD, etc.)