PULSE Program: Physician Registration - Summer Cycle 2022
Matches are sent out in the beginning of July!

Mentorship program
- Get paired up with a premed student (who has applied and been accepted to the program)
- This student will be a student within your university affiliation
- Meet 2-3 times in 2-3 months (virtual and potentially in person if able)
- Discuss your career, education, and specialty with student
- Propose a topic relevant in your field for the student to research
- Deliberate about proposed research topic with student
- Gain and build a meaningful mentorship
- Discuss future opportunities (shadowing, research, etc.) given COVID-19 guidelines

All information is confidential and strictly used for matching purposes.

Please do not hesitate to reach out to our team with any questions. pulse.programinfo@gmail.com

Please confirm your email. *
What is your full name? *
Which medical school did you attend? *
Where do you currently practice? (City, State) *
What hospital do you work at? *
What is your speciality? *
Please choose your general specialty or specialties: *
Required
Are you involved with research?
Clear selection
Do you have any additional degrees?  
If you are a resident please indicate your area training and year.
In our matching process, it can be helpful for mentors and mentees to have similar backgrounds and identities. Are there any aspects of your identity (ex. first generation, low income, ethnic backgrounds, LBGTQ+, etc.) that you would like for us to consider?
Any questions/input concerning our program? (We greatly appreciate any advice to improve or any suggestions)
Do you have any colleagues that you think may be interested? If so, would you be willing to reach out to them and share the program with other potential mentors?
Clear selection
How did you hear about PULSE?
Clear selection
Have you participated in the past as PULSE physician Mentor?
Clear selection
Thank you!
Thank you for signing up to be a physician mentor for the PULSE program. You should be receiving a match within the next few months. We look forward to working with you. Please do not hesitate to reach out with any questions. pulse.programinfo@gmail.com
https://www.pulse-program.org 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy