Latino Medical Student Association Southeast Region Mentee Form
Objectives of the LMSA SE Region Mentor/Mentee program:

1) Create connections between Latino residents/attendings and medical students that can help in the process of creating successful future physicians
2) Allow communication and networking between physicians and students all throughout the Southeast region
3) Create a long lasting, meaningful bond between mentor/mentee that is of significant value to all parties involved
Year in School and Name of Medical School
Email Address
The mentorship program is recruiting physicians from all over the Southeast region. Are you comfortable with being placed with a mentor who lives in a different state?
Clear selection
Is there a specific medical specialty that you are interested in and would like to be assigned a mentor in this field (understand student may or may not be assigned to specific specialty MD depending on availability)
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