PULSE Program: Physician Registration - Summer 2024 Cycle
Matches will be sent out mid-July!

Mentorship program overview:
  • Get paired up with a premed student within your geographical area (who has applied and has been accepted to the program).
  • Meet at least 3 times in 3-4 months (either in-person or virtually).
  • Discuss your career, education and specialty with student. Propose a topic relevant to your research interests for the student to research or discuss other relevant topics and explore mentee's interests.
  • Gain and build a meaningful relationship with mentee.
  • Discuss future opportunities (shadowing, research, etc.).

All information provided in this form is confidential and strictly used for matching purposes.

Please do not hesitate to reach out to our team with any questions. pulse.programinfo@gmail.com
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Email *
First Name *
Last Name *
Email
(Please provide the best email where you can be reached)
 *
Confirm email *
What medical school did you attend? *
Degree
Where do you currently practice? (City, State) *
What hospital do you work at? (if any) *
What is your specialty? *
Please choose your general specialty or specialties: *
Required
If you selected "other", please specify.
Our PULSE Program strives to help students of various backgrounds overcome obstacles to medical education, it can be helpful for mentors and mentees to share similar backgrounds. 

Are there any aspects of your identity (ex. first generation, low income, disabled, ethnic/racial backgrounds, LBGTQ+, etc.) that you would like for us to consider?

If none, write N/A
 *
Are you involved in research? *
Do you have any additional degrees?  
If you are a resident please indicate your area of training and year.
Have you participated in the past as PULSE Physician Mentor? *
Do you have any interest in having 2 mentees? (Not expected at all, we received feedback to ask physician mentors if they are interested in more than one mentee!)
Clear selection
Any questions/input concerning our program? (We greatly appreciate any advice to improve or any suggestions)
Do you have any colleagues that you think may be interested? If so, would you be willing to reach out to them and share the program with other potential mentors?
Clear selection
How did you hear about PULSE?
Clear selection
Thank you!
Thank you for signing up to be a physician mentor for the PULSE program. You should be receiving a match within the next few months. We look forward to working with you. Please do not hesitate to reach out with any questions. pulse.programinfo@gmail.com
https://www.pulse-program.org 
A copy of your responses will be emailed to the address you provided.
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