Mentor Application for ACC MI Mentorship Program
The program is available for fellows in general, imaging, interventional, electrophysiology, and heart failure interested in collaborating with mentors in the field of interest. We are seeking expert in the field like yourself to serve as a mentor for applicants that match you career and clinical interest. The information below will be used to match you with a mentee to promote collaboration.

Program Objectives: To promote the mentee's professional development, provide career guidance, and aid the fellow to explore the available clinical and research opportunities.

For any questions, please contact catarina@accmi.org  
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Name *
Email *
Cell number  *
Institution  *
Expertise *
Required
Specialty  *
Practice setup  *
Please, write a short bio (a few sentences), including areas of research or clinical interest, that we can share with your mentee when matched (300 words)
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