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2023-2024 MENTORS - PsychSIGN Mentorship Interest Form
Thank you for your interest in serving as a mentor for a medical student(s) in PsychSIGN! This program aims to connect medical students interested in psychiatry with later-career psychiatrists to facilitate the building of professional mentor-mentee relationships. We need psychiatrists from all stages (residents, fellows, attendings, academics, community, etc.)

Please fill out the form below to indicate your preferences. This form will help us pair mentors with mentees based on interests, location, and other factors deemed important by the student/physician. The structure of the mentoring relationship will be up to the mentor and mentee to decide, but includes a minimum of 2 meetings, using whatever medium works best for both you and your mentee, for the academic 2023-2024 year. 

Within a few weeks of completing this form you will be matched with a mentee, and your preferred contact information will be shared with the mentee and vice versa.

For successful completion of the mentorship program (meeting at least 2 times with mentee) PsychSIGN will provide a Distinguished Mentor certificate. 

If you have any questions or concerns, please contact our mentorship chair, Luigi Loizzo at psychsignmentorship@gmail.com or our president, Brandon Prunty at psychsign@gmail.com


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Full name *
Email *
Phone *
Preferred contact method *
Required
Preferred gender pronouns *
Current position *
Current institution and state (e.g. Stony Brook University, NY)
Specialty or interests within psychiatry (select all relevant) *
Required
Special interest groups (select all relevant)
How many medical students would you be willing to mentor?  *
Are you interested in mentoring international medical students? *
We ask that mentors commit to speaking with their mentees at least twice in the 2023-2024 school year to make sure that both mentors and mentees are able to have a worthwhile experience. Do you anticipate any issues with maintaining this commitment? *
Do you have any comments or feedback?
Would you like to be contacted in the future about other opportunities to work with PsychSIGN? You would be contacted for things such as presenting at PsychSIGN's national conference, reviewing a student's personal statement, etc.
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How did you hear about PsychSIGN's Mentorship Program?
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