Bridge Conference Registration Bridge to the Future Health Career Pathways Mentoring Conference "*" indicates required fields Student's Name* First Name Last Name Email* Phone*What is your current academic status?* High School Student College/University Student Recent College/University Graduate Graduate Student High SchoolWhat is the name of your current High School?* Indicate Present Academic Status - High School*Select Academic StatusHigh School FreshmanHigh School SophomoreHigh School JuniorHigh School SeniorAccompanying AdultPLEASE NOTE: Chaperone, Parent, or Guardian attendance is required for all high school students.Name of Accompanying Adult* First Name Last Name Relationship to Student*Example: Parent, Guardian, Chaperone, Teacher, etc. Email of Accompanying Adult* Phone Number of Accompanying Adult*College/UniversityIndicate Present Academic Status - College/University*Select Academic StatusCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorAre you currently a UConn Student?* Yes No Which UConn campus do you currently attend?*Select CampusStorrsUConn Avery PointUConn HartfordUConn StamfordUConn WaterburyDo you need transportation from UConn Storrs?* Yes No What is the name of the college/university you currently attend?* Recent GraduateName of College/University* Graduation Year* Graduate StudentGraduate Degree Program* Master's Degree Doctorate Other What is the name of your graduate academic institution?* Other ParticipantWhat is the name of your academic institution? Relationship to Student* DemographicsGender*Select GenderMaleFemaleNon-BinaryPrefer Not to AnswerEthnicity*Select EthnicityAfrican American/BlackAlaskan NativeAsianCaucasianNative AmericanNative HawaiianPacific IslanderPuerto RicanMexican American/ChicanoOther HispanicOtherPrefer Not to AnswerIf Asian, Specify* If Other, Specify* Professional InterestWhat is your career/professional interest?* Medicine Dental Graduate: Biomedical Research Graduate: Public Health Other Final SectionHave you previously participated in any programs sponsored by the Department of Health Career Opportunity Programs?* Yes No If yes, please list the program(s) and the year(s) of participation.*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.