International Medical Doctors (IMD) Mentorship Application

International Medical Doctor Mentorship Program Application Form

Whitetulip Health Foundation
APPLICANT INFORMATION
Name *

First Name Last Name
Email *
example@example.com
In which country are you living now? *

Section to show later
What is your medical expertise and academic background, briefly? *
Do you have a passport? *

Yes No
What is the expiration date? *

Month Day Year
Passport expiration date
Do you have a valid US visa? *

Yes No
Visa Type *
US Visa Type
What is the expiration date? *

Month Day Year
Visa expiration date
Do you have any income or academic position in your current located country? *
Did you start learning the local language in the country where you are located? *

Yes No
Level *
Local language level
Did you start initiating the Medical License procedure in the country where you are located? *

Yes No
How many articles do you have (internationally published)? *
How many citations do you have until now? *
What is your h-index? *
Have you taken any USMLE or OET exams in the past? *

Yes No
USMLE or OET Exam Dates & Scores *
Have you ever worked in the US as a researcher, observer, invited faculty etc.? *

Yes No
Brief explanation of the previous US experiences *
What kind of documents do you have with you? *

Diploma Transcript Curriculum Certificates Deans Letter Good Standing Letter Birth Certificate Other
Do you have a certain plan for a career path in the US (academia-residency-fellowship-faculty)? *

Yes No
Brief explanation of career plans for the US *
What would like to discuss and learn from our IMD Mentorship department? *
What do you expect from our IMD Mentorship department? *
What would your contributions to those who are trying 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 *

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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.

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International Medical Doctor Mentorship Program Application Form

APPLICANT INFORMATION