KAMSA Mentee Sign-up Form
If you are a KAMSA member interested in being paired up with a KAMA or KAMRAF mentor of interest, please fill out this form and we will get back to you with the mentor's contact information if you are paired!
Name *
Email *
Phone number
School *
City & State *
Year (M2, MD/PhD Year 4, etc) *
Specialty of Interest (First Preference) *
Specialty of Interest (Second Preference, if multiple)
Specialty of Interest (Third Preference, if multiple)
What type of mentorship are you looking for? Check all that apply: *
Was there a specific mentor you were interested in being paired with? Please provide their name and institution here:
Is there a certain institution or city/state in which you would like a mentor? Please indicate here and we will try our best to accommodate.
[Optional] Would you like to be paired with a female mentor as part of the Women in Medicine mentoring program?
Clear selection
Is there anything else you'd like us to know?
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