ASCO Mentoring Program - Mentor Interest Form

Thank you for your interest in serving as an ASCO mentor.

ASCO offers a variety of mentoring opportunities to our members, from one-time, situational mentoring to long-term, structured mentoring programs. Through our mentoring initiatives, we aim to pair participants with a mentor who can support their individual learning and professional development needs.

After completing this interest form, ASCO staff will use this information as we seek mentors for our various mentoring needs. If you are identified as a mentor match, ASCO staff will follow-up with more details about your prospective mentee prior to finalizing the mentoring relationship.

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* 1. Contact Information

Full Name

Institution

Email Address

Assistant Email Adress

ASCO ID Number

Designations (i.e. MD, MBBS, PhD, etc.)

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* 2. In what country do you work?

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* 3. Membership Category

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* 4. Short Mentor Bio

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* 5. Practice Setting

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* 6. Area(s) of Specialty

Specialty 1

Specialty 2 (optional)

Specialty 3 (optional)

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* 7. Research Experience

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* 8. Mentoring Experience

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* 9. Why are you interested in mentoring and what do you hope to gain as a mentor?

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* 10. Please select the mentoring relationship(s) that you are most interested in participating in:

Long-term, formal mentoring relationship (one-year, structured program)

Short-term situational mentoring relationship (opportunities outside of the ASCO Annual Meeting)

Annual Meeting mentoring (opportunity to serve as an onsite mentor during the ASCO Annual Meeting only)

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* 11. Please select mentee(s) that you are most interested in mentoring

International mentees

Mentees from underrepresented populations in medicine

Trainees (medical students, residents, fellows)

Early-career oncology professionals

Mid-career oncology professionals

Women in Oncology

Medical Educators

Patient Advocacy/ Patient Advocates

Global Oncology

Other (please specify)