Mentorship Survey (Mentee)

Thank you for your interest in the Association of Medicine and Psychiatry’s mentorship program!  This template is designed to collect the information of those individuals who are SEEKING A MENTOR to discuss stages of career, development, advantages of combined training or practice.

What type of training program are you interested/enrolled in?
If you are a medical student, what is your medical school?
If you are a resident, what program are you in?
If you are an ECP, what kind of practice do you currently have?
I prefer my mentor have a practice in...
I prefer a mentor trained in...