ACMA Mentoring form

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ACMA Mentoring form

Please fill in this form if you are interested in becoming a mentor to YACMA medical students or ACMA house surgeons

Name: *

E-mail: *

Mobile Phone number: *

Specialisation *

G.P.

Physician

Surgeon

If you are a physician/surgeon, please indicate your specialty

What is your preferred method of contact with the mentee? *

Face-to-face meetings

E-mail

Phone/skype calls

No preference

Other:

Required

List any preferences you feel are important in the matching process? *

i.e. time, activities, meetings, availability, students with research interests etc.

General comments

Provide us with any suggestion/comments

Submit

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