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Resident/Fellow Looking to Mentor a Medical Student
Basic Information
First Name:
MI:
Last Name:
Gender:
- Select -
Male
Female
Non-binary
Prefer not to answer
Email:
Current Institution:
Country:
Are you an STS member? Mentors are required to be STS members.
Apply here
.
- None -
Yes
No
What is your Member ID?
Stage of Training
CT Surgery Residency Program Type:
- Select -
Traditional 2-3 year residency program
Integrated 6-year residency program
Combined 4/3 residency program
PGY:
PGY:
- Select -
PGY 1
PGY 2
PGY 3
PGY 4
PGY 5
PGY 6
PGY 7
PGY 8
Other…
Please specify:
Anticipated CT Surgery Residency Completion Date:
CT Surgery Interests
Please indicate your area of interest. Select all that apply.
Adult Cardiac
General Thoracic
Congenital
Undecided
Other
Please specify:
Objectives
In what areas are you interested in mentoring? Select all that apply.
Residency Application Process
Residency Interviews
CT Surgery Rotations
Awards and Scholarships
Research
Clinical Advice
Career Development
Work/Life Balance
Leadership Development
Networking
Issues of Inclusion/Diversity
Wellness
Why are you interested in serving as mentor?
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