MSDCI National: Mentorship Program (Mentor Interest Form)

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Thank you for your interest in being a mentor in MSDCI National's Mentorship program!

What is this mentorship program? 

- This program is designed to make a 1:1 connection between a pre-med or medical student with disability and/or chronic illness ("mentees") with a current MSDCI medical student member ("mentors"). 

- After you complete at least 3 mentorship sessions, you will receive a Volunteer Certificate that certifies you have participated as a mentor in MSDCI National's Mentorship Program.

- MSDCI National is facilitating these mentor-mentee connections. However, the exact nature of the mentor-mentee discussions will be up to you! We recognize that living with a chronic illness and/or disability comes with its unique set of experiences and challenges, and we aim to better support our community members through their journeys navigating medicine. 

- Please note that we recognize that you are volunteering your time for this program, so we ask that mentees do not ask for direct review of their medical school or residency applications unless it specifically relates to their chronic illness and/or disability. A full set of Community Guidelines for mentors can be found here.

Who can participate? Any current medical students who are interested in participating as a mentor (i.e. getting matched 1:1 with a medical student or premed mentee) are welcome to fill out this form!

How does the mentor-mentee matching program work?

1. You fill out this form

2. You will be added to our listserv of mentors. On a biweekly (every 2 weeks) basis, you will be emailed a spreadsheet containing de-identified information about mentees. This will include any demographic information that they specifically indicate they are comfortable sharing, as well as a brief paragraph that they will submit.

3. You will sign up for mentees whom you are interested in being matched with using the spreadsheet mentioned above. We suggest starting with 1-2 mentees. Once a match is made, we will pass on the mentee's contact information and preferred contact method so you can reach out to them. 

4. Each time you complete a mentoring session, you will be asked to complete a brief form. This will help us keep track of the mentorship sessions (and to improve our program). After completing at least 3 mentorship sessions, you will receive a Certificate stating that you are a mentor in this program. Certificates will also be sent out to mentors every 6 months, or earlier upon request. These certificates will indicate how many mentorship sessions you have completed with us in total.

What is the expected timeline? Because we are relying on our mentors to volunteer we cannot guarantee that we will be able to match you with anyone. However, we will reach out within 8 weeks to update you. If you have not heard an update from us 8 weeks after you have submitted this form, please reach out at mentorship@msdci.org

Who can I contact if I have questions about this mentorship program? Please reach out to  mentorship@msdci.org and a member of our leadership team (Zak, Kelsey, and/or Amy) will get back to you within 1 week!

Where can I learn more about MSDCI? You can visit our website at www.msdci.org and join our Listserv by emailing msdcinational@gmail.com

Email *
What is your name? *
What is your email address? *
What is your phone number?
What is your preferred method of contact?
Are you currently a member of MSDCI? Please note that membership of your medical school's MSDCI Chapter and/or membership of MSDCI National (defined as being signed up for our Listserv) is required to be a participant in this program. *
Required
Demographic Information
Please note that you are not required to disclose any of your identities. We are collecting this information as part of an ongoing review of this program, which is helping us understand which identities our community members hold, so that we can better provide inclusive support and resources. 

All of this information will be deidentified (i.e. your name or personal contact information will not be linked to any of these identities) when we conduct our aggregated analysis. 
What best describes where you currently are in your educational journey? *
How would you describe your gender identity? *
Required
How would you describe your racial and/or ethnic background? Please check all that apply.
 *
Required
Which of the following disability/chronic illness 'categories' best describes you? Please check all that apply.
 *
Required
Which of the following groups or identities, if any, describe you? Please check all that apply.
 *
We are collecting this information as part of an ongoing review of this program which is helping us understand which identities our community members hold, so that we can better provide inclusive support and resources. 

All of this information will be deidentified (i.e. your name or personal contact information will not be linked to any of these identities) when we conduct our aggregated analysis. 

Please note: URM is defined by the American Association of Medical Colleges as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population". This has historically included individuals who identify as Black, Mexican-American, Native American (American Indian, Alaska Native, and Native Hawaiian), and/or mainland Puerto Rican.
Required

Please indicate here what types of topics you feel comfortable discussing (i.e. use of accommodations in medical school, disability disclosure to mentors, etc.). You can also include the shared identities that you are hoping to have with your mentee.

Please only include what you are comfortable with, and we will do our best to match you with someone as appropriate. 

Examples of what to include are: 1) what you are hoping to gain from this program and what questions or topics you'd like to discuss with your mentee, and 2) if there are any particular identities or life experiences that are important to you and that you would like your mentee connect with you about.

(500 word limit)

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How did you hear about this program? Please check all that apply.
A copy of your responses will be emailed to .
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