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Mentorship Participant Application 2025
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1.
Name:
(Required.)
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2.
Email address:
(Required.)
3.
Phone Number:
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4.
Career Focus:
(Required.)
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5.
Institution/Hospital:
(Required.)
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6.
City, Country:
(Required.)
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7.
Time zone:
(Required.)
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8.
What advice are you looking for in a mentor? (pick 1 and only one):
(Required.)
Setting up a Clinical Practice
Setting up a Research Career
Navigating Academic Medicine
Navigating Innovation and Medical Device Design
Developing Clinical Skills and Reasoning
Managing a Clinical Practice or Team
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9.
What values and qualities do you consider important for a mentor? (Pick 2 and only two):
(Required.)
Giving feedback
Active listening
Motivating others
Availability
Conflict Management
Being open minded
Dynamic communication
Being Honest
Being Empathetic
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10.
What are your greatest strengths? (Pick 2 and only two)
(Required.)
Having a positive attitude
Taking initiative
Following through on commitments
Being an engaged listener and communicator
Being open minded
Dynamic communication
Being honest
Being empathetic
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11.
What is an area of weakness for you as a mentee? (Pick 2 and only two):
(Required.)
Difficulty with project completion
Struggling to receive constructive feedback
Setting unrealistic or 'too-high' standards for others or oneself
Needing to be liked all the time
Difficulty with goal setting
Dear of asking questions
Difficulty with multitasking
Being overcommitted or 'stretched too thin'
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12.
Would you be willing to work with a mentor outside of your field?
(Required.)
Yes
No
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13.
What do you consider to be your professional areas of expertise?
(Required.)
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14.
What are your hobbies and interests outside of your career?
(Required.)
