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Application to Become a Virtual Advisor Please note: All advisors must have completed a residency program and must hold a medical school appointment (at least instructor). |
| First Name: |
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| Middle Name/Initial: |
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| Last Name: |
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| Suffix (Jr., PhD, etc.): |
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| Gender: |
Male
Female |
E-mail
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(If you wish to participate in this program, your email address must be
entered above.) |
| Do you have a Medical School appointment? |
Yes
No
If Yes: |
| Medical School:
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What region is your institution? |
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| If Other, Medical School: |
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Are you a member of SAEM? |
Yes
No
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Do you have prior experience as a Medical Student Advisor? |
Yes
No
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If yes, please describe briefly: |
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Other qualifications or areas of expertise: |
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Would you be interested in meeting with your
advisee(s) at a national or regional meeting? |
Yes
No |
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How many students are you willing to advise? |
1
2
3
4
5 or More
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If more than five, please provide a
maximum number |
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Note: Clicking submit will send an email to the virtual advisor program.
You will receive confirmation via email once a virtual advisee has been assigned.
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