2025 Trainee Mentorship Program - Mentor Recruitment Application

General Information

Question Title

1. Full Name

Question Title

2. Email address

Question Title

3. Profession

Question Title

4. Institution/Organization

Question Title

5. Area of Expertise

Question Title

6. Preferred Mentorship Areas

Career Planning and Progression

Research Design and Methodology

Grant Writing and Funding Strategies

Manuscript Writing and Publication

Clinical Practice Development

Work-Life Balance

Networking and Professional Relationships

Leadership and Management Skills

Transition to Independent Practice or Faculty Role

Equity, Diversity, and Inclusion in Cardiovascular Health

Question Title

7. Languages Spoken

Arabic

Chinese

English

French

German

Hindi

Italian

Japanese

Portuguese

Russian

Spanish

Other (please specify)

Question Title

8. Preferred communication methods

Phone

If preferred communication is phone, please enter your number below

Question Title

9. Availability

Once a week

Once a month

Once every 2 months

Once every 3 months

Other (please specify)

2025 Trainee Mentorship Program - Mentor Recruitment Application

General Information

Question Title

1. Full Name

Question Title

2. Email address

Question Title

3. Profession

Question Title

4. Institution/Organization

Question Title

5. Area of Expertise

Question Title

6. Preferred Mentorship Areas

Question Title

7. Languages Spoken

Question Title

8. Preferred communication methods

Question Title

9. Availability

Question Title

10. Please confirm that you are available to invest at least 1h/month as a CCS mentor

Question Title

11. Headshot - For mentorship webpage

Question Title

12. Short bio - For mentorship webpage

Question Title

* 1. Full Name

Question Title

* 2. Email address

Question Title

* 3. Profession

Question Title

* 4. Institution/Organization

Question Title

* 5. Area of Expertise

Question Title

* 6. Preferred Mentorship Areas

Question Title

* 7. Languages Spoken

Question Title

* 8. Preferred communication methods

Question Title

* 9. Availability

Question Title

* 10. Please confirm that you are available to invest at least 1h/month as a CCS mentor

Question Title

* 11. Headshot - For mentorship webpage

Question Title

* 12. Short bio - For mentorship webpage

1. Full Name

2. Email address

3. Profession

4. Institution/Organization

5. Area of Expertise

6. Preferred Mentorship Areas

7. Languages Spoken

8. Preferred communication methods

9. Availability

10. Please confirm that you are available to invest at least 1h/month as a CCS mentor

11. Headshot - For mentorship webpage

12. Short bio - For mentorship webpage