I am an alumna/alumnus of Hahnemann Medical College, Hahnemann University College of Medicine, Woman's Medical College, Medical College of Pennsylvania, MCP Hahnemann, or Drexel University College of Medicine and I would like to particpate in the eMedical Mentoring Program:

Items indicated by an asterisk (*) are required.

* First Name:

* Last Name:

Gender:

Degree:

*My School:

My Graduation Year (4 digits):

*My City (no abbreviations):

*State:

*Zip:     
*E-Mail:

My Specialty
Primary:

Other:

Residency/Fellowship Training Program(s):

I have done a military residency or fellowship.

Current employment: employer and job title

Areas of special interest:

Topic(s) I would be willing to speak on:

I am willing to serve as a resource for (please check all that apply):

Careers in my specialty area of medicine
Careers in my specialty area of research
Family and career issues
Shadowing experiences
Participating in the Program for Integrated Learning Practicum*
*if you have your own site and would be willing to take a first year student for two months (May and June). For more information about the Program for Integrated Learning, please view the web site.

I am willing to host students during residency, fellowship,
        or employment interviews

Additional Information, comments, or special requests:

Do you have any other alumni you would recommend as mentors?

Your information will be kept private. Your e-mail address will only be made available to current students who are seeking a mentor that matches your profile, and to the Alumni Office.