2023-2024 Mentorship Program Application for Residents 2023-2024 Mentorship Program Application for Residents 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 transitional year/residents for a 1:1 mentee-mentor ratio focused on pediatric dermatology research. 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 Institution as of September 1, 2023 Please select your program:DermatologyPediatricsOther Please specify: Are you planning to apply or have you matched to a dermatology residency program?Yes, I have applied and matched.Yes, I have applied, but not yet matched.No, I am not planning to apply to a dermatology residency program. Please tell us where you'll be doing your dermatology residency program? Please select your current standing:Transitional Year InternSecond Year ResidentThird Year ResidentFourth Year ResidentOther Please specify: Do you know where you'll be doing your pediatric dermatology clinical fellowship?YesNo Please tell us where you'll be doing your pediatric dermatology clinical fellowship? In what year do you expect to complete residency? YearPlease select... 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 What type of research are you interested in and/or currently performing? Check all that apply. Basic ScienceClinicalEpidemiologyIndustry sponsored researchQuality ImprovementTranslationalOther 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 (genetics sub-group) 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 indicate your top four (4) areas of interest. 360 degree 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: Are you interest in mentoring a group of no more than 3 medical students?YesNo Were you a mentee in the 2022-2023 PeDRA Mentorship Program?YesNo Please outline the skills you learned and/or projects you started while in the 2022-2023 Mentorship Program. (250 word maximum) Please tell us about your current research projects and/or any projects you have worked on in the past. (250 word maximum) Please tell us why you would like to be considered as a mentee for the 2023-2024 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 provide this information. Other Please specify: Please upload a current CV. By checking this box, you agree to meet with your mentor a minimum of three times throughout the mentorship year (October 2023-September 2024) 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
