Mentor Preference Form

Your name

Your email

Your phone number

Your year

What gender do you identify as?

Would you prefer someone with the same gender identity as you? Please note we will try our best to match you with someone of your preference but we cannot guarantee it.

Your racial identity

Would you prefer someone with the same racial/ethnic identity as you? Please note we will try our best to match you with someone of your preference but we cannot guarantee it.

Are there other identities you find important for you to share with your mentee? If so, please list them below.

What areas would you like to mentor?

What are some of your career interests and goals in healthcare? Please list your career interests and goals as keywords with commas between each one: [Interest 1], [Interest 2], etc. Examples of career interests and goals include health equity, women's health, research, etc.

What are some of your hobbies and interests outside of medicine/healthcare? Please list your keywords with commas between each one: [Interest 1], [Interest 2], etc. Examples of interests outside of medicine/healthcare include sports, music, dance, etc.

Please indicate how many hours a week you'd like to be a mentor for

If you were an ice cream flavor, what ice cream flavor would you be and why?

Anything else you'd like us to know?

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