GI-MAP Mentor Sign-Up Form

Thank you for your interest in the Gastroenterology Mentorship and Advancement Program (GI-MAP)!

This program connects Pediatric & Internal Medicine residents with GI fellows for mentorship and guidance as they explore a career in gastroenterology.

As part of GI-MAP, we are also conducting a research study to assess the impact of mentorship on career confidence and GI fellowship applications. Your responses will help us refine this program and contribute to mentorship research.

Participation in the research study is optional. You may still join GI-MAP without participating in the study.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email:

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* 4. Phone Number [Optional]

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* 5. Fellowship Training:

Adult Gastroenterology

Pediatric Gastroenterology

Other (please specify)

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* 6. Year of Fellowship Training:

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* 7. Current Institution:

25% of survey complete.