Faces in Family Medicine 2017-18 Mentors
KAFP is excited to have you join the Mentor team for this academic year to share your face of Family Medicine!

By completing this Mentor Application you will be paired with pre-med and/or med students to mentor for the academic year. Organizers will do their best to pair you with students interested in areas of medicine you focus on.

Expectations for participation:
- Mentors will attend at least one campus dinner.
- Mentors will make four points of contact t throughout the academic year.

Which type(s) of students would you like to mentor? Select all that apply. *
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How many students would you be comfortable mentoring? *
Which campus location(s) would you prefer your student be based out of? Select all that apply. *
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Which campus location(s) would you be able to attend a group mentorship dinner at? Select all that apply. *
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What about your practice makes you feel it is unique? Select all that apply. *
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Which forms of communication are you comfortable with for communicating with your student? Select all that apply. *
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First Name *
Your answer
Last Name
Your answer
Email *
Your answer
Cell Phone *
Your answer
City, State *
Your answer
Do you have any colleagues you'd encourage KAFP to invite to be a mentor? Please provide their name and KAFP will follow up on your behalf.
Your answer
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