VSHP Mentorship Program Pharmacy Student Sign-Up

Welcome to the VSHP Mentorship Program Pharmacy Student Sign-up page. We are excited that you are interested in participating in this program.

The form below is for current students who would like to participate in the VSHP Mentorship Program and receive a pharmacist mentor. VSHP Mentors are health-system pharmacists and/or pharmacists who are current residents. Mentors are there to answer any questions about your career and offer advice about pharmacy. The VSHP Mentorship Program Committee will do their best to match you up according to your preferences so please be specific.

As a reminder, the student requirements are the following:
1. Must be a current pharmacy student member of SVSHP who have completed their first year of pharmacy school.
2. Desire to be a mentee (being receptive to learning, developing a learning relationship with a mentor)
3. Be receptive to the advice and counsel of the mentor

If you have any questions, please contact the Mentorship Program Chairs or Steve Glass, Executive Director of VSHP at contact@vshp.org.

The deadline to apply is October 25, 2019.

Thank you!
Name *
Your answer
Pharmacy School *
Pharmacy School Graduating Year (i.e. "2019") *
You must have completed your first year of pharmacy school to be eligible for this program (i.e. a current P2 - P4).
Your answer
E-mail Address *
Please use your university e-mail address.
Your answer
Address While You Attend School *
This will be given to your pharmacy mentor unless otherwise specified.
Your answer
Phone Number *
Please format as (XXX) XXX-XXXX. This will be given to your pharmacy mentor unless otherwise specified.
Your answer
What area of pharmacy are you interested in? *
Feel free to pick more than 1 option below. The VSHP Mentorship Committee will do our best to match accordingly. If you are open to any type of health-system pharmacy, please select the last box!
Please indicate any previous work experience related to pharmacy. *
Type N/A if no previous experience.
Your answer
Do you have any particular requests of a mentor?
Ex: Mentor gender preference, you wish to be matched at your hometown rather than where you are enrolled in school- indicate home address, etc.
Your answer
What are your expectations for the VSHP Mentorship Program? *
Please indicate what you envision the mentorship program providing you/what you hope to gain and what you believe you will need to put into the program. Thank you!
Your answer
Any other comments or questions?
Please indicate any thing you believe is vital for the VSHP Mentorship Committee to know, or any questions you would like the Mentorship Committee to contact you about.
Your answer
Have you submitted your CV via email to contact@vshp.org? *
In recognition of the commitment that my mentor will take by agreeing to this program, I agree to respect my mentor’s schedule, to be mindful of my communication with my mentor, and to allocate time to establish a relationship with my mentor. *
Please type your first and last name below to signify your agreement with the above statement.
Your answer
Never submit passwords through Google Forms.
This form was created inside of Virginia Commonwealth University. Report Abuse - Terms of Service