ACLAM Mentor Registration Application
Application to become a mentor for ACLAM's Mentoring Program.
NOTE: Once you have registered, your information will be retained indefinitely. Please contact us at aclammentor@aclam.org if you would like to change your contact information or be removed from the database.
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Email *
Name (First, Last) *
Phone number *
Current title(s) and institution(s), including location *
I would like to mentor someone in (pick any that apply) *
Required
How did you qualify for ACLAM board certification? *
I would like this mentoring relationship to last for (pick any that apply): *
Required
In order for our committee to match you with the right individual, please provide any information that you feel would facilitate the best possible selection. For example: your years of experience, areas of expertise, ACLAM board certification via experience or residency track , nonhuman primates, aquatics, pharma, government, military, LAM leadership, foreign graduate, ECFVG, demographics, and prior mentorship experience including but not limited to laboratory animal medicine, etc. *
A copy of your responses will be emailed to the address you provided.
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