Assessment
This form is used to collect information from Medical Professionals (Researchers/Practitioners) who are interested in mentoring aspiring medical students (Internship/Residencies) in the US.

This project is called : EVOLVE :-
E - Explore
V - Virtue of
O - Obeisance ( namaskar ) towards
L - Life by
V - Volunteering and
E - Educating

Once we receive the below information from you DFS team will reach out to you and map student(s) based upon interest and your availability at the given time
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Email *
First Name *
Last Name *
Phone number *
Email *
Medical Degree: *
Area of Specialty *
Name of Institute you graduated from *
Name of the Institute of your current or last  Practice *
 City of current or last practice or research *
 City of current Residence *
Would you be interested in ( you can select more than 1 ) *
Required
Number of years you have been in practice or research *
Your Achievements *
How many hours a week, can you allocate to mentoring? *
How many students can you mentor at any given time? *
Disclaimer : - By checking the box below, we understand that we are voluntarily entering into this mentoring relationship that shall benefit both the mentor and mentee in intangible ways.  This initiative is meant to be a rich, rewarding experience to help illuminate the mentee’s path to a residency program in the United States.  Other than guidance and advice, there shall be no further expectation of any tangible or specific benefits by either party.  The mentoring relationship will continue as long as both parties feel comfortable with its productivity.  Finally, by participating in this program, I agree to allow Sewa International the right to use my name, photograph, and/or video in the promotion of these services for future such participants through social media and other channels.
 *
A copy of your responses will be emailed to the address you provided.
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