CDS Dermatology Underrepresented in Medicine Mentorships (DURM) - 2023 Award Year
A full-time, one-month dermatology mentorship for current U.S. medical students who have completed First Year M1 Modules
Name
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First Name
Last Name
Preferred Name (if different)
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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-
Month
-
Day
Year
Date
Preferred Pronouns
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Languages spoken/read (please specify)
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High School
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Please also list city/state or country, as well as years attended
College
*
Please also list city/state or country, as well as years attended
Medical School
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Please also list city/state or country, as well as years attended
Primary Mentor or Advisor
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Please also provide contact information
May we contact the above Mentor/Advisor as a reference?
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Yes
No
Underrepresented Status (if no such status, enter "N/A")
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Maximum length is 20 words.
0/20
Disadvantaged Background Status (if no such status, enter "N/A")
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Maximum length is 20 words.
0/20
Please upload a current CV
*
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Please upload a copy of your medical school transcript
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Please provide a personal essay about yourself
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Maximum length is 250 words.
0/250
Why are you interested in this mentorship opportunity and what impact could this experience have on your future career direction?
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Maximum length is 250 words.
0/250
Letter of Recommendation (at least one letter required)
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Please provide name, affiliation, and contact information for one individual who has agreed to provide a letter of recommendation to support your application. One letter of recommendation must be received by Monday, March 6, 2023 at 11:59 pm to complete your application. It is up to the applicant to ensure that the letter of recommendation is received by the deadline. Please provide your selected individual with the following link where he or she will be able to upload the recommendation letter - https://form.jotform.com/220755821548157. Please note that recommendation letters must be kept confidential from the applicant and must be uploaded directly by the author of the letter.
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