Rural Surgery Mentorship - Mentor Interest

Mentors and mentees meet at quarterly web-based meetings to discuss the rewards, challenges, and training path to a fulfilling career in rural surgery.

All meetings are held virtually through Zoom, 8:00-9:30pm ET. Confirmed meeting dates for the 2021-2022 Program are as follows:

September 29, 2021
January 12, 2022
March 30, 2022
June 22, 2022

Your name*

Contact email*

Contact phone*

Hospital/Institution*

Current Specialty (if applicable)

Please describe what you are looking for in a mentee and what you hope to gain from participating in this program.*

I am available to participate in the 2021-2022 Mentorship Program*

Yes
No

(If applicable) I am NOT available for the dates listed for the 2021-2022 Mentorship Program but would be interested in having my name kept on file for future Program cycles

Please keep my name on file

Submit