Please enable JavaScript in your browser to complete this form.Please complete this form to the best of your abilityLayoutEmail *Your emailPreferred email address *Your emailHighest degreeMDPhDMPHMSMAOther:Other:Full name *Your answerLocation : City, Country *Your answerSpecialtyYour answerType of practiceClinicalResearchAdministrativePrivateConsultantConciergeAcademicHospitalOther:Other: Academic rankLecturerInstructorAssistant professorAssociate professorFull professorN/AOther:Other: LayoutCurrent practice institutionYour answerCurrent academic affiliationYour answerMentorship information (Do you have experience in mentorship)YesNoWhom did you mentor?UndergraduateGraduateDoctoralResidentsFellowsJunior facultyPeersOther:Other:Duration of your mentorship experience Round to the nearest yearYour answerParticular areas of interest for mentorship? Please choose oneBasic research (e.g. designing a study, developing skills, data analysis)Clinical research (e.g., patient recruitment, study design, funding)Career development- transitioning from training to staff or faculty, areas of interest, and specialty choice and preparednessTraining advice (e.g., navigating residency and applications)Writing skills (e.g., grants, manuscripts, abtracts, personal statement, communication)Personal development (e.g., leadership/negotiation, CV)Please choose the career development focusAcademicHospital-basedPrivate soloPrivate groupGlobal health/AdvocacyAssuming one-hour mentorship, how many sessions can you allocate? One mentee is allocated per mentorOnce weeklyOnce every 2 weeksOnce every 3 weeksOnce every 4 weeksLayoutHow did you hear about the mentorship program?Social mediaWord of mouthEmail communicationILMA sectionOther:Other:What is your preferred mode of communication?In-person, face-to-face (only in the USA)TelephoneE-mailVirtual meetingBiographic questions Briefly explain your career trajectory and interest in mentorship * Limit 1000 charactersHow do you expect mentorship to enhance your professional career? * Limit 1000 charactersSubmit
