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What is your classification?
 
Freshman
 
Sophomore
 
Junior
 
Senior
 
Graduate Student
 
 
 
Please list your major(s)/minor(s)/concentration(s):
   
 
 
 
Would you be interested in serving on an SEM committee?
 
Volunteer
 
Fundraising
 
Mentoring
 
Event Planning
 
Other
 
 
 
 
Which area(s) of medicine/engineering is(are) currently of greatest interest to you?
 
Medical Equipment Engineering
 
Implants/Prosthetics
 
Surgery
 
Clinical Practice
 
Clinical Research
 
Biomedical Research
 
Pharmaceuticals
 
Other (please specify)
 
Other
 
 
 
 
How often would you like to see meetings planned?
 
Weekly
 
Every 2 weeks
 
Every 3 weeks
 
Monthly
 
Other
 
 
 
 
Please mark if you would be interested in attending any of the following trips
 
DCH Hospital – Tuscaloosa
 
UAB School of Medicine/UAB Hospitals
 
UAB Graduate School
 
Wright Medical - Memphis (implant technologies)
 
Centennial Hospital - Nashville
 
Surmodics – Birmingham (drug delivery)
 
Baxter Health Care - Greenville, MS (sterile packaging)
 
Other
 
 
 
 
Which event(s) would most interest you?
 
Advising dinner with pre-health and engineering faculty
 
Medical and/or engineering-related volunteering
 
Mentoring (pairing upperclassman and underclassman SEM members)
 
 
 
Would you attend a meeting if the speaker were only available via Skype?
 
Yes
 
No
 
 
 
What do you most hope to get out of SEM this year?
   
 
 
 
Comments/Suggestions:
   
 
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