OUWB Prospective Mentor Interest Form
Thank you for considering serving as an Embark mentor. The information you provide here will be distributed to our new first year students later in the academic year (early in the Winter semester). We hope that students and mentors discuss potential projects and find best-case scenarios for all parties involved. Please let us know if you have any questions!
Dwayne Baxa, Douglas Gould, Victoria Roach and Kara Sawarynski
Embark Program Directors
Title, Academic Rank and/or Highest Attained Degree
Please list the best email address to contact you with more details and any questions
Phone Number and Best Time to Be Reached
Place of Employment and/or affliiation - please indicate your primary affiliation
Department / Discipline
I am interested in becoming an Embark Program Mentor for future OUWB Medical Students.
Possibly - I'd like more information
Please indicate the Embark Program project type you are interested in mentoring
Choose more than one if applicable
Basic or Translational Research
Community Based Research
Medical Education Research
K-12 or Undergraduate Education Research
Health Management / Leadership / Policy Research
Medical Humanities Research
Patient Safety / Quality / Information Tech Research
Please briefly describe research topics you have expertise in and/or opportunities for projects you are interested in pursuing.
Please provide detail here as to the research topics you are interested in and have resources to support. Given the current pandemic circumstances, projects that may be able to (at least in part) progress remotely will be valuable to students. These may include spin-offs of current medical or resident student projects, as well as general topics of interest. Ideally you as a Mentor will find a Student with similar interests to pursue a mutually beneficial project (with an independent aim/arm for the student's Embark Program project). This information will be made available to the students later in the academic year.
Are you currently an Embark Program mentor (or have you previously mentored)? Please note that departmental approval & sign-off is required for any mentor to have more than 5 total students (M1-M4) at any one time.
Additional Comments or Questions
Thank you for your continued support of our students and the Embark Program!
If you have any questions, please contact
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