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Sign up to be a Mentee!
1.
Please enter the following information:
Name
Date
Organization/Affiliation
Email
2.
Select your current status:
Student
Intern
Resident
Early Career
Established seeking new skills
3.
AAP Membership Status:
National Only
Maine Only
National and Maine
4.
Please identify the primary reason(s) you seek a mentor:
Deeper knowledge of a clinical topic or subspecialty
Interest in Research
Interest in Advocacy
Interest in Volunteerism
Interest in Leadership
Interest in Early Career Growth
Other
Other (please specify)
5.
If you seek a mentor around a clinical subject, please choose from the list below or add your topic
Allergy and immunology
Anesthesiology
Dermatology
Emergency medicine
Family medicine
Hematology/Oncology
Hospital Medicine
Infectious Disease
Internal medicine
Neurology
Ophthalmology
Palliative Care
Pathology
Primary Care
Pulmonology
Psychiatry
Surgery
Urology
Other (please specify)
6.
Do you anticipate this being a short duration consultation or are you seeking a mentor for a longer duration?
Shorter duration/consultation
One year or more
Not sure
Other (please specify)
