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Thank you for showing interest and completing this survey. Connecting our students with you is crucial for providing essential support as they embark on their journey in medicine. Your expertise and mentorship can significantly shape their growth and boost their confidence in the medical field. We appreciate your willingness to collaborate and make a positive impact on the next generation of physicians.

Please take the survey below to communicate your interest in getting in touch with our students.

Contact Information:

First and Last Name

Email Address

Phone Number

ext. (if applicable)

Practice Information:

Medical Specialty

Subspecialty/Fellowship (if applicable)

What is the name of the primary hospital or clinic where you work?

Current Role (e.g., PD, APD, Year in Residency, etc.)

What is your preferred method of communication (select all that apply)

email
phone
in person
Zoom

What are your goals for collaborating with OCRA? Please select all that apply:

Provide mentorship to students
Host workshops
Participate in networking events
Support research initiatives
Volunteer as a faculty advisor
Serve as a mock interviewer
Participate in our virtual specialty roundtable
Engage with our specialty student interest groups
Other (please specify)

Are there any preferences on time and/or method of communication our office can contact you (ie- no texts before 9am, available for zoom most Weds/Thurs after 5, etc.)