Mentorship - USMLE Department

Post Medical Graduate Mentorship Program Application Form

Whitetulip Health Foundation

section - if member
Do you have an unexpired Whitetulip Health Foundation membership?*

YesNo

section - Informations to fill
APPLICANT INFORMATION
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Current Residence (City, State, Country)*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Medical School*
Graduation Year*
Current Job/Position*
Medical Specialty Interest(s)*
What is your goal to achieve as part of this program?*
Please upload your current CV and unexpired membership verification letter as two separate attachments.*

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Terms and Agreements (Please accept all of the conditions)*

Each applicant will be assigned a mentor once his/her application is accepted.The mentorship program is limited to maximum of 1 year (12 months) for each of USMLE Steps. If an applicant cannot take his/her examination within 12 months of enrollment, the mentorship program will be terminated at the end of this period.Each applicant can only be enrolled once in the mentorship program for the same USMLE Step.Applicants are expected to give permission to WHF USMLE Center to collect/store their relevant personal and professional information to be able to provide mentorship services.Applicants are expected to maintain an open loop of communication with their mentors throughout mentorship program (by email, text or phone calls). Failure to do so will result in termination of mentorship services.Applicants are expected to report their academic progress regularly in appropriate channels guided by the mentorship program. Failure to do so will result in termination of mentorship services.Times of our mentors are quite valuable as they voluntarily spend their time for their mentees. WHF USMLE Center expects all mentees to treat their mentors with appreciation and respect all the time.Although it is not an absolute requirement, mentees enrolled in the program are expected to provide mentorship services to younger generations once they take respective USMLE Steps successfully.
Signature*

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Today's Date

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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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Post Medical Graduate Mentorship Program Application Form

APPLICANT INFORMATION