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Sign up to be a Mentor!
1.
Please enter the following information:
Name
Organization/Affiliation
Email
2.
Current status:
Practicing Primary Care Setting
Practicing Hospital Setting
Practicing Other Setting
Late Career
Retired
3.
AAP Membership Status:
National Only
Maine Only
National and Maine
4.
Which primary area(s) or focus do you wish to share in this mentoring experience:
Primary field of medicine
Specific clinical topic
Advocacy
Volunteerism
School health
International/Travel medicine
Leadership
Career Development
5.
If you have expertise in a particular area(s), please select it from the list below.
Advocacy
Allergy and immunology
Anesthesiology
Dermatology
Emergency medicine
Family medicine
Hematology/Oncology
Hospital Medicine
Infectious Disease
Internal medicine
Leadership
Neurology
Ophthalmology
Palliative Care
Pathology
Primary Care
Public Health
Pulmonology
Psychiatry
Research
Surgery
Urology
Other (please specify)
6.
Do you prefer to mentor a colleague or a trainee/student/resident? (check all that apply)
Colleague established in their career
Resident
Intern
Student
7.
What length of time are you willing to serve in this role?
six months
one year
More than one year