MAA internship pilot program 2024 - Volunteer Form

Application of Interest for Medical Alumni Association (MAA) Internship Pilot Program 2024

First name

Last name

Email address

Physical address of internship site

Number and Street Name (line 2)

City

State

Zip Code

Preferred phone number

Home

Business

Mobile

Phone number

UCSF affiliation (select all that apply)

Degreed Alum

Resident Alum

Clinical Fellow Alum

Class Year

I am available to participate in online orientation and individual training with CSEO staff in November and December.

Please note these 2023 dates in which I have conflicts or other considerations

I am available to mentor a high school student up to five hours a week for 12 weeks between January 10-April 10, 2024.

Please note these 2024 dates in which I have conflicts or other considerations

What interests you in mentoring a high school student?

Who would you like to mentor? What shared interests or background do you think your mentee should have to most benefit from your internship?

Do you have mentoring experience as a mentor or mentee in an equity access program, or other student-focused leadership training or career development program?

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