2023-2024 Mentorship Program Application for Clinical Fellows 2023-2024 Mentorship Program Application for Clinical Fellows Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Welcome to the 2023-2024 PeDRA Mentorship Program. This year, PeDRA will accept 10 Clinical Fellows for a 1:1 mentee-mentor ratio. Please submit your application by 5PM PST, Thursday, September 14, 2023 to be considered. Late applications will not be accepted. If you have questions about the program or the application, please email PeDRA's Associate Director of Education, Jenn Dawson. Contact Details First Name Last Name Credentials Email Position/Title Institution What is the specialty area of your clinical fellowship? Pediatric DermatologyPediatricsDermatologyOther Please specify: The 2023-2024 PeDRA Mentorship Program has two options for mentees to select from. Mentees may apply for the traditional PeDRA mentorship option of 1:1 pairing. In the traditional program, mentors and mentees have the flexibility to discuss a variety of topics. New this year, a mentee may apply to be a part of a small research-intensive group (4 mentees maximum) focused strictly on mentorship within the following areas: translational research, basic science research, or industry sponsored research. Are you interested in applying for one of the research-intensive groups?Yes, basic science researchYes, translational researchYes, industry sponsored researchNo, I would like to have a traditional 1:1 mentor. Please tell us why you would like to be considered as a mentee for the research-intensive mentorship track? 250 word maximum What type of research are you interested in and/or currently performing? Check all that apply. Basic ScienceClinicalEpidemiologyQuality ImprovementIndustry sponsored researchTranslationalOther Please specify: Please select the top four (4) PeDRA Focused Study Groups that are of the most interest to you. Acne & Hidradenitis Suppurativa Atopic Dermatitis & Psoriasis Birthmarks Connective Tissue & Autoinflammatory Disorders Down Syndrome (sub group of genetics) Drugs & Bugs Genetic Skin Disorders Hair Disorders Neonatal Skin Care Skin of Color & Pigmentary Disorders Skin Tumors & Reactions to Cancer Therapies (STARC) Cross-Cutting Please select the top four (4) skills that are of most interest to you. 360 leadership Academic promotion Conducting basic science research Conducting translational research Developing a niche Grant writing Manuscript peer review Negotiation/conflict resolution Networking SMART goal setting Statistics Study design/execution Work/life balance Working with industry Working with patient advocacy Other Please specify: Do you plan to attend any of the following meetings in the coming year? Please check all that apply.PeDRA Annual Conference - November 9-11, 2023, Atlanta, GAAmerican Academy of Dermatology - March 8-12, 2024, San Diego, CASociety for Investigative Dermatology - May 15-18, 2024, Dallas, TXSociety for Pediatric Dermatology - July 11-14, 2024, Toronto, CanadaOther(s) Please specify: Were you a mentee in the 2022-2023 PeDRA Mentorship Program?YesNo Please outline the skills you learned or projects you started while in the 2022-23 PeDRA Mentorship Program. (250 word maximum) In addition to receiving mentorship during the 2023-2024 term, you have the opportunity to serve as a mentor to either one resident, or a group of medical students (maximum of 3). Mentors will receive a small monetary stipend for their support. Please indicate your interest in also serving as a mentor below:I would like to mentor a resident.I would like to serve as a mentor to a small group of medical students (maximum of 3). I am not interested in serving as a mentor at this time. Please tell us about your current research projects and/or any projects you have worked on in the past. (250 word maximum) Please use this space to tell us about your future career and research goals. (250 word maximum) Please tell us why you would like to be considered as a mentee for the 2023-2024 PeDRA Mentorship Program. (250 word maximum) Demographics PeDRA is committed to supporting equity, diversity, and inclusion across all facets of its organization, programs, committees, leadership, and research studies. All data collected is kept safely and only de-identified aggregate data may be shared for strategic purposes. Please specify your gender: FemaleMaleNon-binaryI do not wish to provide this information. With what race(s) do you self-identify? Please select all that apply. American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Middle Eastern or Northern African Native Hawaiian or other Pacific Islander White I do not wish to provide this information. Other Please upload a current CV. By checking this box, you agree to meet with your mentor a minimum of three times with in the program year, either by phone or in-person.Yes, I agree Save my progress and resume later | Resume a previously saved form Contact Information Return to Mentorship program Overview
