ACLAM Mentee Registration Application
Application to become a mentor for ACLAM's Mentoring Program
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Email *
Name (First, Last) *
Phone number *
Current title(s) and institution(s), including location *
I would like mentorship in (pick any that apply): *
Required
I would like this mentoring relationship to last for (pick any that apply): *
Required
In order for our committee to match you with the right mentor, please tell us specifically what you are looking for in a mentor. For example: area of expertise, ACLAM board certification route (residency vs. experience route), career advancement interests, industry vs. academia vs. military track, demographics, recently boarded and any other preferences that may be useful for our committee to know when making match recommendations. *
A copy of your responses will be emailed to the address you provided.
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