Orientation Registration Form

Please complete the form below. After completing the form, please be sure to pay the Orientation Fee when this is available. Your student orientation fee covers you for materials and activities and is required of all students.

Submit your Orientation Registration by July 1, 2023.

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

Day of Service (optional)

About the Day of Service

Will you be attending?

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

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.