Alternative Pathways Mentorship Application

Alternative Pathways Mentorship Program Application Form

Whitetulip Health Foundation

section - if member
Are you a member of Whitetulip Health Foundation? *

Yes No

section - informations to fill
APPLICANT INFORMATION
Name *

First Name Last Name
Email *
example@example.com
What is your medical expertise and academic background, briefly?
How long you have been in the USA?
What would like to discuss and learn from the physicians who currently practice in the USA?
What are three most challenging conditions in the USA you experienced?
To overcome the difficulties you are experiencing in the USA, what do you expect from the physicians who currently practice medicine in the USA?
What are your experience, positive or negative? Can you please share those experiences with us so that we can help better the ones who would like to come to the USA in the future?
What would your contributions to those who are already in the USA and trying to integrate into the US Medical System or those would like to come to the USA in the future?
Could you please write two references who are members of Whitetulip Health Organization? (The candidates are required to write minimum of two references to get mentorship serves.)
Reference 1:
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Country Code Phone Number
Reference 2:
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Country Code Phone Number
Please Upload Documents *

Please, upload your unexpired membership verification letter, CV and relevant documents
Cancel of
Signature of Applicant *

Clear
Today's Date *

Month Day Year
WE RESPECT YOUR PRIVATE, SENSITIVE, AND CONFIDENTIAL INFORMATION

All your private, sensitive, and confidential information received by Whitetulip Health Foundation will only be used to evaluate and process your mentorship application. We exercise extreme care and discretion when handling such information. Your personal information, in any circumstances, will not be shared with other individuals or organizations without your permission.

BEWARE OF SCAMMERS!

Whitetulip Health Foundation does not initiate contact with our members, volunteers, and/or applicants by email, text messages or social media channels to request their personal, sensitive, confidential, or financial information, including requests for SSN, passwords, or access information for credit cards, banks or other financial accounts.

If you receive such a request this might be a scam! Please contact us immediately.
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Alternative Pathways Mentorship Program Application Form

APPLICANT INFORMATION