Sign up to be a Mentee! Question Title * 1. Please enter the following information: Name Date Organization/Affiliation Email Question Title * 2. Select your current status: Student Intern Resident Early Career Established seeking new skills Question Title * 3. AAP Membership Status: National Only Maine Only National and Maine Question Title * 4. Please identify the primary reason(s) you seek a mentor: Deeper knowledge of a clinical topic or subspecialty Interest in Research Interest in Advocacy Interest in Volunteerism Interest in Leadership Interest in Early Career Growth Other Other (please specify) Question Title * 5. If you seek a mentor around a clinical subject, please choose from the list below or add your topic Allergy and immunology Anesthesiology Dermatology Emergency medicine Family medicine Hematology/Oncology Hospital Medicine Infectious Disease Internal medicine Neurology Ophthalmology Palliative Care Pathology Primary Care Pulmonology Psychiatry Surgery Urology Other (please specify) Question Title * 6. Do you anticipate this being a short duration consultation or are you seeking a mentor for a longer duration? Shorter duration/consultation One year or more Not sure Other (please specify) Done
