MENTORSHIP/RESEARCH INTEREST FORM
This form is designed to help us connect paediatric residents, paediatric subspecialty fellows, and MSc/PhD candidates interested in mentorship, research, and career guidance within Pediatric Hospital Medicine. Our goal is to facilitate connections and support tailored to your interests and professional aspirations. Please complete the form with as much detail as possible to help us ensure a strong match.
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Email *
Full Name *
Current Position/Title (please include year of residency if applicable)
 *
What is your affiliated university? *
What prior degrees do you have, or what degree programs are you currently enrolled in?
 *
Required
Email address *
What kind of mentorship are you seeking? (Select your top 2 choices)
 *
Required

What, if any, prior research experience do you have?

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If you are a PhD/MSc candidate, what is your specific research topic or area of interest?

Please provide details on your research focus and how mentorship can support your work and professional development. 

Is there a specific research methodology that you are hoping to gain experience in?

Examples: Quantitative, qualitative, clinical trials, Quality Improvement, or any other research methods you are considering.
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What are you hoping to gain from this mentorship program?  *
Are you interested in learning more about the PIRN Trainee Advisory Committee (TAC) community? https://www.pirncanada.com/become-a-trainee
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