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MSD Mentorship Participation Survey

You are invited to participate in MSD's Mentorship Program

Participating as a mentor, a mentee (or both) allows you the opportunities to establish and cultivate relationships that match your desired level of participation.  Connecting one-on-one, providing/receiving support and guidance and engaging with medical professionals will benefit you at all times of your medical career.
Please take a few minutes to complete this brief survey so we can enroll you in the program and get started.
I am interested in being:(Required.)
I am interested in being a part of the MSD Mentorship Work Group to help plan activities, match mentors with mentees and provide support to this program(Required.)
Name(Required.)
Medical Specialty(Required.)
Please choose the appropriate status
(Required.)
Graduation/training dates
Location of practice/training(Required.)
Scope of Practice/Area of Practice(Required.)
Preferred method(s) of communication (check all that apply)(Required.)
Preferred interval of communication(Required.)
Hometown(Required.)
If participating as a MENTEE, what areas would you like to focus on during this mentorship? (Select up to 3)
If participating as a MENTEE, which is your preferred mentor background?
If participating as a MENTOR, what categories of mentorship can you offer? (Select all that apply)
If participating as a MENTOR, How many mentees can you take on? (1, 2, or 3)?
If participating as a MENTOR, do you prefer mentees in your specialty/department or open to all?
If participating as a MENTOR, is there anything else you'd like the mentorship workgroup to consider when assigning mentees?
Professional/Medical interests (top 3)(Required.)
Personal Interests (top 3)(Required.)
Please provide your contact information so we may contact you regarding next steps.(Required.)
Current Progress,
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