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Medical Student Registration — Mentorship Program

Medical Student Registration — Mentorship Program

Inclusion is a key priority of our mentorship program. As part of the registration process, we will be asking a few demographic questions. Please share as much or as little as you are comfortable with.

Please note that while we ask some demographic information, the information you inidcate as being a priority for your mentor will be our priority in creating your match.

First Name *

Last Name *

Email *

Cell Phone Number *

Pronoun(s) *

They/Them

She/Her

He/Him

Language(s) spoken *

Hometown/Region/First Nation *

What year of Medical School are you starting this fall? *

In which region would you like to practice? *

Other

Please share some personal interests or hobbies *

Please enter at least 1

Please share some professional interests *

Please enter at least 1

Why are you interested in this program? *

Please rank - how important are the following criteria for your mentor? (1 being most important)

Shared interest in a specific medical field

Shared personal interests

Shared demographic (religious or cultural community)

Have you previously participated in the program

Yes

If yes, what is your previous mentor's name.

Is there anything else we should know about you?

Is there anything else we should know about your ideal mentor?

(Optional) Do you have children?

Yes

Prefer not to disclose

(Optional) I am a member of a 2SLGBTQIA+ community:

Yes

I would like to provide more information

(Optional) I identify as a member of the following Racial or Ethnic Group

(Optional) I identify as a member of this spiritual/religious group:

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Medical Student Registration — Mentorship Program