Transition and stay connected Survey

First name(Required.)

Last name(Required.)

Degree(s)(Required.)

Last role/title at MGH(Required.)

Personal email (not MGH/MGB email)(Required.)

MGH/MGB email

Brief description of the areas of interest that you would like to be involved in.(Required.)

Which area(s) of interest would you like to be involved in? Check all that apply.

Mentoring (ex. research, conference planning, program development, career development)

Teaching (ex. complex case management)

Writing (ex. grant writing, manuscript writing, etc.)

Committee Service (ex. search committees, grant review)

Fundraising

Advocacy (ex. strengthening clinical support, getting the vote out)

Other (please specify)

Please comment on how you'd like to be involved in mentoring.