Mentor Connection Interest Form

This is an excellent opportunity to build your professional network and earn flexible volunteer hours while producing meaningful medical education content. By participating, you will connect 1-on-1 with a leader in healthcare to gain unique insights that help grow our collective library of resources.

Important Advisory: Please be aware that this connection will be recorded, edited, and posted to the Healthcare Stories YouTube channel. These recordings serve as a vital resource for health education and help us grow a public library of mission-driven leadership stories.

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Full Name *
Email Address *
How familiar are you with the concept of Social Determinants of Health (SDOH)? *
Not at all familiar
Very familiar
Intended Professional Program (e.g., MD, DO, DDS/DMD, PA, etc.) *
In one sentence describe what inspires you to pursue a career in healthcare? *
Agreement & Consent: By submitting this form, I agree to be recorded and understand that this footage will be edited and shared publicly for health education purposes. I also confirm that I have obtained explicit consent from my mentor to be recorded and featured in this video library.
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