CVCSCCM Mentor Mentee Program (MMP) Sign-up
Email address *
Are you an ACTIVE member of the CVCSCCM chapter? (your membership status will be confirmed prior to the mentor-mentee match)* *
Title *
Last Name *
First Name *
Middle Name
Credentials *
Email *
Email Confirmation *
Institution
City *
State *
Job Title *
Area(s) of Practice: Check all that apply *
Required
Years of experience in critical care practice *
Are you a trainee (e.g. student, resident)? *
Would you like to participate as a mentor, mentee, or both? *
If you would like to participate as a MENTOR, please indicate what areas you would feel comfortable offering mentorship in: *
Required
If you would like to participate as a MENTEE, please indicate what areas you would like mentorship: *
Required
Would you like to be paired with someone in your own profession or another profession? *
Required
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