Legacy Connect Inquiry Form

Legacy Information

Legacy Physician's Name*

Alumnus/a, Former Housestaff, Former Faculty

Relationship to Student*

Parent, Grandparent, etc.

Email*

Cell Phone*

Street Address

City

State

Zipcode

Spouse Name

Student Information

Student Name*

Student's Email*

Educational Snapshot*

Please provide name, city/state location, and year of graduation for high school and undergraduate college/university (if not completed, please include expected graduation year).

GPA and MCAT

Please provide current GPA and MCAT score (if available)

Has the student already applied to the UVA School of Medicine?*

What is the student's projected matriculation year for medical school?*

Scheduling your Visit

When would you and your family like to visit the School of Medicine?*

Please provide as specific a date range as possible.

Additional Comments/Questions

Resources For...

Students

Alumni

Housestaff

Faculty

Legacy Connect

Legacy Information

Student Information

Scheduling your Visit