Sign up to be a Mentor! Question Title * 1. Please enter the following information: Name Organization/Affiliation Email Question Title * 2. Current status: Practicing Primary Care Setting Practicing Hospital Setting Practicing Other Setting Late Career Retired Question Title * 3. AAP Membership Status: National Only Maine Only National and Maine Question Title * 4. Which primary area(s) or focus do you wish to share in this mentoring experience: Primary field of medicine Specific clinical topic Advocacy Volunteerism School health International/Travel medicine Leadership Career Development Question Title * 5. If you have expertise in a particular area(s), please select it from the list below. Advocacy Allergy and immunology Anesthesiology Dermatology Emergency medicine Family medicine Hematology/Oncology Hospital Medicine Infectious Disease Internal medicine Leadership Neurology Ophthalmology Palliative Care Pathology Primary Care Public Health Pulmonology Psychiatry Research Surgery Urology Other (please specify) Question Title * 6. Do you prefer to mentor a colleague or a trainee/student/resident? (check all that apply) Colleague established in their career Resident Intern Student Question Title * 7. What length of time are you willing to serve in this role? six months one year More than one year Done
