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 students. 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!

Thank you!
Dwayne Baxa, Kyeorda Kemp, Victoria Roach and Kara Sawarynski
Embark Program Directors

For more information on Mentor Roles & Responsibilities, please view a short video at http://bit.ly/EmbarkMentorRoles.
First Name *
Your answer
Last Name *
Your answer
Title, Academic Rank and/or Highest Attained Degree *
Your answer
Email Address *
Please list the best email address to contact you with more details and any questions
Your answer
Phone Number and Best Time to Be Reached *
Your answer
Place of Employment and/or affliiation - please indicate your primary affiliation *
Department / Discipline
Your answer
I am interested in becoming an Embark Program Mentor for future OUWB Medical Students. *
I am interested in attending an upcoming Embark Program Mentor Open House, and would like more information. *
Please indicate the Embark Program project type you are interested in mentoring *
Choose more than one if applicable
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. 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 incoming students at the beginning of the academic year.
Your answer
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
Your answer
Thank you for your continued support of our students and the Embark Program!
If you have any questions, please contact embark@oakland.edu.
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