Orientation Registration Form

Please complete the form below by June 23, 2025

After submitting the form, please be sure to pay the Orientation Fee. Your student orientation fee covers you for materials and activities and is required of all students.

Submitting Proof of CPR?

If you are submitting proof of CPR, do not pay using the above link. Please wait for approval and a different link from Julie Szrama.

Orientation-Registration

Note: A field with an red asterisk * denotes a required field.

Student Information

First Name:*

Preferred First Name:
(for orientation name tag)

Last Name:*

Pronouns:
(Pronouns will be printed on your clinical ID badge and class rosters)

Mobile Phone:*

Secondary Phone:

Personal Email:*
(not affiliated to any institution)

Hometown:*

State:*

Undergrad Institution:*

Student Affiliation:

Please select the categories that apply to you. Note: Per your submission, you may be placed into an orientation group or offered programming that reflects your affiliation.

Non-traditional (2 or more gap years before starting Medical School)
Parenting student
Military
First-generation (First in your family pursuing an MD degree)

Person Number:

UBITName:

Your "UBITName" is the username assigned to you that you will use to log into a variety of campus services, including MyUB and HUB (to register for classes), UBmail, UB Learns, UBbox file storage and sharing and software downloads like MS Office.

Student Sizes

T-Shirt Size (unisex):*

White Coat:*

Lab Coat Size Chart

Size	XXS	XS	S	M	L	XL	2XL	3XL	4XL
Ladies Dress	2-4	6-8	10-12	14-16	18-20	22-24	26-28	30-32	34-36
Ladies Chest	36 ¼	40 ¼	44 ¼	48 ¼	52 ¼	56 ¼	60 ¼	64 ¼	68 ¼
Mens Jacket	26-28	30-32	34-36	38-40	42-44	46-48	50-52	54-56	58-60

CPR/BLS Certificate

You will automatically be enrolled in a CPR class that will occur during Orientation. If you already have an active CPR/BLS Certificate and would like to opt out of this course, please check “yes” below and upload your completion certificate.

Opt-out of CPR/BLS course:

Yes

White Coat Ceremony

About the white coat ceremony

Phonetic Spelling
We want to ensure that we pronounce your name and hometown accurately during the ceremony. Please provide phonetic pronunciations to help us.

Phonetic First Name:*

Jason would be Jay-Sun or Jay-son

Phonetic Last Name:*

Voorhess would be vore-hes

Phonetic Hometown:*

Buffalo would be Buff-eh-low

Phonetic Undergrad Institution:*

UB would be You Bee

If a physician (must be an MD and a Jacobs School faculty) will be hooding you, please indicate his/her name and relation. More specific information will be sent to students prior to the White Coat Ceremony.

Physician First Name:

Physician Last Name:

Physician Preferred Email:

Relation:

NOTE: This individual should wear his/her white coat and sit on stage with faculty at the ceremony.

Special Diet Requests

Vegan
Vegetarian
Gluten-free
Dairy-free

Halal
Kosher
Nut Allergy

Accept Digital Communications Guidlines

Photo and Promotional Release

I hereby consent to be interviewed, recorded, photographed, videotaped or filmed by representatives of the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo for purposes of publication, display or broadcast (print, web, digital display, social media, and all other forms of media).

I agree that such interviews, recordings, articles, quotes, photographs, films, audio or video and/or any reproductions of same in any form, are the property of the University at Buffalo, and I relinquish any present or future claim for reimbursement for said photographic or film reproduction of my likeness or for said testimonials by me.

I hereby release the University at Buffalo, its affiliates, employees, representatives and agents from any and all claims, demands, costs and liability that may arise from the use of these interviews, recordings, photographs, videotapes or films, and/or any reproductions of same in any form, as described above, arising out of being interviewed, recorded, photographed, videotaped or filmed.

I acknowledge that I have read this consent form in its entirety, or it has been read (or translated) to me, and I have had the opportunity to ask questions about it and understand it.

I have read and agree to the guidelines

Photo and Promotional Release Form

Parent/Family Member Information

Parent / Family Member names and email addresses are being collected to help keep them informed of upcoming events.

Name:*

E-mail: *

Indicate N/A if you would not be interested to provide this information

+ Add another

Name:

E-mail:

Attention Parents: Join Parents Council

All medical student parents are encouraged to join the Parents Council. For more information and to join, please see their website.