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KAMSA Mentee Sign-up Form
If you are a KAMSA member interested in being paired up with a KAMA or KAMRAF mentor of interest, please fill out this form and we will get back to you with the mentor's contact information if you are paired!
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone number
Your answer
School
*
Your answer
City & State
*
Your answer
Year (M2, MD/PhD Year 4, etc)
*
Your answer
Specialty of Interest (First Preference)
*
Your answer
Specialty of Interest (Second Preference, if multiple)
Your answer
Specialty of Interest (Third Preference, if multiple)
Your answer
What type of mentorship are you looking for? Check all that apply:
*
Specialty-focused mentorship
Research
Networking
Shadowing/clinical opportunities
Casual discussion
Other:
Required
Was there a specific mentor you were interested in being paired with? Please provide their name and institution here:
Your answer
Is there a certain institution or city/state in which you would like a mentor? Please indicate here and we will try our best to accommodate.
Your answer
[Optional] If possible, would you like to be paired with a female mentor as part of the Women in Medicine mentoring program?
Yes
Clear selection
Is there anything else you'd like us to know?
Your answer
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