Women in Surgery Committee (WiSC) Mentorship Program -
2020 Mentor Application

Application Deadline: June 30, 2020

The WiSC Mentorship Program Mentor application is open to female Fellows of the ACS who have more than ten years in practice.

Your commitment as a Mentor would be a minimum of one mentor-mentee contact per month.

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* 1. Please provide your information below.

Name

Institution

City

State

Phone

Current Specialty

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* 2. Select the option that best describes your work environment:

Private practice

Academic / Teaching Institution

Employed physician

Community hospital

Rural hospital

Other (please specify)

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* 3. Have you previously served as a professional mentor ?

Yes

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* 4. Have you previously served as a mentor for the ACS Women in Surgery Program?

Yes

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* 5. If you have mentored previously, please list the program and the capacity you served as a mentor:

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* 6. If selected, are you able to devote time over the next year to supporting your mentee on a minimum of a quarterly basis?

Yes

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* 7. What expertise do you feel most qualified to share with your mentee? Please select all that apply.

Career development

Research goals

Work / Life balance

Transition to practice

Leadership development

Other (please specify)

Thank you for your interest and application. The WiSC Mentorship committee will review all applications and match Mentors with Mentees. You will hear from the WiSC committee by the end of July.

Please click the 'done' button below to submit your application.

Questions? Contact Carol Christian at cchristian@facs.org