Mentee Undergrad and Med Students Application

Mentorship in Medicine Application - Mentee - Undergrads, Post-Grads and Medical Students

Please complete this form in its entirety to apply as a Mentee in the Mentorship In Medicine program.
Mentor and Mentee matches are based on specialties, geographic proximity, and more, with biosketches provided to help each pair connect. Over the course of five months, pairs meet at least once a month — in person or virtually — and choose from a list of activities that deepen these bonds. For example, they can meet for lunch or coffee or attend a CME or a SSVMS event together. Meeting guidelines and a list of suggested activities and prompts will be provided to help mentors and mentees navigate their discussions with ease.

The first five-month session will begin in August 2025. Mentees will be notified if they are accepted in the program no later than July 2025.

Application deadline is June 30, 2025.

Residents and practicing physicians interested in being mentored, please do NOT fill out this form. Your interest form is located here.
Student Name*

First NameLast Name
Student Email (Please provide a PERSONAL email address, not a school address)*
example@example.com
Student Cell Phone Number*
Please enter a valid phone number.
Current city of residence*
Date of birth*

MonthDayYear
Date
College or Medicine School attending/College Graduated*
Have you attended the Future of Medicine or the Mentorship in Medicine program in the past?*

Yes, in-person summer programYes, in-person spring programYes, virtual summer programYes, Mentorship in Medicine, One-on-OneNo
Mentorship Matching

To help us identify a good mentor match, please answer the questions below.
Gender: How do you identify?*

ManNon-BinaryWomanPrefer not to discloseOther
How would you best describe your race/ethnicity? *Select One or More*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderWhitePrefer not to say
What is your primary language? *
What medical specialties interest you? *
Type N/A if you are open to any specialty.
Please upload a short essay, 400-500 words, or a 1 min video describing how this program will help you pursue your career goals. Answer the following questions: Why are you interested in a career in medicine? What medical specialties interest you most? What qualities do you think make a good physician? What are your goals for the future? Why do you want a mentor physician? Please share about your family, hobbies, extra curricular activities, volunteer work, and notable accomplishments to assist us in ensuring a solid mentor match.*

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Please upload a current/most recent college or medical school transcript*

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Current GPA*
How did you hear about this program?*

My school/teacher/counselorFellow student/friendCareer fair/public eventGoogle/online searchOther
Comments
Please read and check that you acknowledge the following-*
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Mentorship in Medicine Application - Mentee - Undergrads, Post-Grads and Medical Students

Mentorship Matching