JMSA Shadowing Program--Mentors' Survey

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Thank you for taking the time to fill out this 2 page survey.

We have created a mentorship program for the Japanese community interested in pursuing academics (medicine, science, etc.). This program will group participants--high school, college, medical/graduate students, physicians, and scientists--who have gone through or will continue in the education system in the US in order to help each other advance in the academic field. We hope that this program will also enhance our sense of camaraderie within JMSA as well as in the Japanese community!

First Name *

Last Name *

Email *

Are you interested in the shadowing or advising mentorship program? *

Shadowing only

Advising only

Both

What is your occupation? *

Please check as many as applicable.

Physician in US

Physician in Japan

Dentist

Psychologist

Research Scientist

Physical Therapist

Speech Therapist

Occupational Therapist

Nutritionist

Nurse

Podiatrist

Optometrist

Physician Assistant

Other:

Required

Undergraduate College *

Medical/Graduate School *

Residency Institution and Specialty

Fellowship Institution and Specialty

Faculty Institution and Specialty

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