NYCDS Mentorship Program Questionnaire

The NYCDS Mentorship Committee is in the process of initiating a Mentorship Program for the benefit of all members, including residents, newer dentists, and established dentists. If you are interested in participating as a mentor or a mentee, please fill out the form below. A mentor is defined as a "seasoned" dentist. A mentee is defined as a resident or new dentist.

The Committee will match mentors and mentees based on the information you provide. In addition, we are planning an Orientation/Meet & Greet Event on January 26, 2023 at 6:00 pm at NYCDS for all participants. Thereafter, we will be holding interest-specific meetings on a quarterly basis. We guarantee that whether you are a mentor or a mentee, you will find this to be a most rewarding endeavor.

If you have any questions, please contact our office at the phone number or email address below.
Phone: 212-573-8500
Email: info@nycdentalsociety.org
https://www.nycdentalsociety.org/

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Name *
I'd like to participate as a:
 *
Email *
Office Address *
Office Phone Number *
Cell Phone Number *
Are you a GP? *
Specialty (if applicable) *
Dental School *
Grad Year *

Past Residency Programs (include year of completion)

 *
For Current Residents - Residency Program/Year of Completion
For Current Residents - Are you interested in general practice or a specialty?
Continuing Education Topics of Interest (please list three)
 *
Dental Interests (Check all that apply)
 *
Required
Please list your hobbies:
 *
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