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2025/26 WPDC Mentor/Mentee Sign-Up
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* Indicates required question
Are you interested in being a mentor or mentee? (Please submit for each if you are interested in signing up for both)
*
Mentor
Mentee
Are you a CMDA member? (required for mentors, preferred for mentees)
*
Yes
No
What is your first and last name?
*
Your answer
What is your email address?
Your answer
What is your cell#?
Your answer
Where do you live?
Your answer
What's your preferred way of communicating?
email
text
FaceTime or call
Clear selection
Where are you in your career?
*
Medical Student
Resident
Attending
Other:
What specialty do you work in or are interested in working in?
*
Your answer
Are you married?
Yes
No
Clear selection
Do you have children?
Yes
No
Clear selection
What are you looking for in this mentorship program? (Community, career/life advice, paying it forward, prayer partner, etc.)
Your answer
Do you have any comments or requests for us?
Your answer
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