OUWB Prospective Mentor Interest Form

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Thank you for considering serving as an Embark mentor. The information you provide here will be distributed to our first-year students searching for a mentor. We hope that students and mentors discuss potential projects and find best-case scenarios for all parties involved. Please let us know if you have any questions!

Email *

First Name *

Last Name *

Title, Academic Rank and/or Highest Attained Degree *

Are you currently a resident or fellow? *

Yes

Other:

Email Address *

Please list the best email address for first year students to contact you.

Phone Number and Best Time for first year students to reach you *

Place of Employment and/or affiliation - please indicate your primary affiliation *

OUWB

Oakland University

Corewell Health

Other:

Department / Discipline *

I would be happy to individually talk with first year medical students about my field/research, and help them network with prospective Embark mentors. *

Yes

Maybe

I am interested in becoming an Embark Program Mentor for future OUWB Medical Students. *

Yes, I am interested in being listed as a prospective Embark Mentor

Possibly - I'd like more information

I am not interested in mentoring, but would be happy to help students network

I am not interested in participating with the Embark Program this year

Please indicate the Embark Program project type you are interested in mentoring *

Choose more than one if applicable

Basic or Translational Research

Clinical Research

Community Based Research

Medical Education Research

K-12 or Undergraduate Education Research

Systematic Reviews

Health Management / Leadership / Policy Research

Medical Humanities Research

Patient Safety / Quality / Information Tech Research

Other:

Required

Please briefly describe research topics you have expertise in and/or opportunities for projects you are interested in pursuing. *

Please provide detail here as to the research topics you are interested in and have resources to support. These may include spin-offs of current medical or resident student projects, as well as general topics of interest. Ideally you as a mentor will find a student with similar interests to pursue a mutually beneficial project (with an independent aim/arm for the student's Embark Program project). This information will be made available to the students later in the academic year.

Are you currently an Embark Program mentor (or have you previously mentored)? Please note that departmental approval & sign-off is required for any mentor to work with more than 5 total students (M1-M4) at any one time. *

Yes

Additional Comments or Questions

Thank you for your continued support of our students and the Embark Program!

If you have any questions, please contact embark@oakland.edu.

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