Pediatric Emergency Medicine Mentorship Program Sign-Up

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This mentorship program is designed to connect medical students, residents and fellows with faculty mentors in pediatric emergency medicine for guidance regarding training, career planning, education and research in PEM. This form will allow you to sign up as a mentor or mentee in pediatric emergency medicine.

Email *

What is your Name *

What is your current institution and location? *

What year will you graduate? (if applicable)

Are you interested in becoming a mentor or mentee? *

Mentor

Mentee

Are you a student, resident, fellow, or attending? *

Medical Student

Pediatric Resident

Emergency Medicine Resident

Fellow

Attending

Other:

What are your interests related to pediatric emergency medicine?

What are you looking to gain from this mentorship program?

Are you planning on applying for fellowship?

Yes

Maybe

Other:

Clear selection

Thank you for your participation in our mentorship program!

Submit

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