University of Minnesota / Medical School Duluth
Office of Curricular Affairs, 109 Med / 1035 University Drive / Duluth, MN 55812

Name: Student ID#: Entering Class: 2011

Classification/Site: (Where you spent the majority of your first 18 years, choose from "Classification/Site" below; Choices 1 - 8.)

Sex: Male: Female: Minority (Optional): Yes: No:

    Classification/Site Table
What Type of Practice do you plan to enter?   1. Large City (pop. 500,000 or more)
Primary Care Choices:
  2. Suburb of a large City
Family Practice:   3. City of Moderate Size (pop. 50,000 to 500,000)
General Pediatrics:   4. Suburb of moderate size city
General Internal Medicine:   5. Small City (pop. 10,000 to 50,000-other than suburb)
Other: If known specify:   6. Town (pop. 2,500 to 10,000-other than suburb)
Undecided:   7. Small town (pop. less than 2,500)
    8. Rural/Unincorporated area
    9. Undecided or no preference

How did the following influence your choice of UMD?

  Strongly Positive Influence Moderately Positive Influence No Influence Moderately Negative Influence Strongly Negative Influence
1. Published emphasis on Family Practice
2. Published Emphasis on Rural Practice
3. Small Class Size
4. Student/Faculty interaction
5. UMD Admissions Process
6. Basic Science Curriculum
7. Amount of clinical Experience
8. Problem-Based Learning
9. Preceptorship Opportunity
10 Other

Which of the items listed below was the MOST influential in your choosing UMD (Choose One)?

1. Published emphasis on Family Practice
2. Small Class Size
3. Admission Application Experience
4. Basic Science Curriculum
5. Clinical Science Curriculum
6. Problem Based Learning
7 Preceptorship Opportunity 8. Other - Specify:
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