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Application to the Academy of Mentoring Advancing Via Individualized Mentoring (AIM)
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1.
Name:
(Required.)
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2.
Email:
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3.
Department:
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4.
Current Rank
(Required.)
Medical Student
Graduate Student
Resident
Instructor
Assistant Professor
Associate Professor
Professor
Professional Staff
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5.
Mentoring Experience & Interests: Describe any past mentoring roles/experiences
(Required.)
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6.
List areas in which you have specialized knowledge or strong intntrest
(Required.)
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7.
Briefly describe your personal goals for participating in the Mentoring Academy
(Required.)
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8.
Updated CV
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