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The information in this section is shared in our mentor network directory for Black, Latinx, and Native American medical students.

If you are NOT interested in being paired with one scholar for a full academic year, skip to the end.

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ElevateMeD Mentors

I would like to automatically re-enroll in the ElevateMeD Mentors Network.

Yes, I'm interested in being paired with one scholar.

1-1 Mentorship opt-in

Our Mentorship Committee will review your profile when pairing our next cohort of ElevateMeD Scholars

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First Name *

Last Name *

Preferred Display Name *

May be used for Mentor spotlights in ElevateMeD communications. ex: Ricardo Correa, M.D.

Company

Department

Job Title

Email (primary) *

Used to receive ElevateMeD system and campaign communications.

Cell Phone *

Time Zone *

Birthday *

Address Line 1

City *

required

State/Province *

required

Zip/Postal Code

Country *

required

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Preferred Pronouns *

ex: she/her; he/him, they/them, etc.

Named Credentials *

ex: Ricardo Correa, M.D., EsD, FACP, FACE, CMQ

Email (shared) *

Email shared in Mentor Network Directory

Mentor Practice Company *

ex: Mayo Clinic

Mentor Practice Type (select all that apply) *

Academic

Government

Private

Mentor Practice City *

ex: Scottsdale

Mentor Practice State *

ex: AZ

Physician Degree *

M.D.

D.O.

Medical Specialty (currently practicing) *

ex: Neurology, Neuro-Oncology, Hospice/Palliative Medicine

Medical School *

ex: Emory University School of Medicine

Residency Location (University/Institution) *

ex: Yale University School of Medicine

Residency Program / Specialty *

ex: Pediatrics

Residency Year Completed *

ex: 2008

Profile Photo *

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Identify as

Black/African-American

Latinx

Native American / Alaska Native

Native Hawaiian / other Pacific Islander

Asian

White

Other

Prefer Not to Disclose

select all that apply

Non-Medical Skills

ex: business, law, leadership, etc.

Brief Bio

Please include your particular passion regarding medicine, research experience, community involvement, etc.

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Membership Level *

I would like to automatically re-enroll in the ElevateMeD Mentors Network.

First Name *

Last Name *

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Data Privacy & Consent

Yes, I would like to receive communications from ElevateMeD by SMS. I agree to receive promotional message sent via autodialer. This agreement isn't a requirement for any purchase or contribution. You may receive 4 msgs/mo. You may opt out at anytime. Reply STOP to end or HELP for help. Terms & Privacy Policy can be found at elevatemed.org/terms. Standard text message rates may apply.