Post-Graduation Plans (if currently in dental school):
* Practice Setting Desired:
* Leadership/Volunteer Positions Held:
* Non-Dental-Related Hobbies:
Professional Interests (e.g., organizations, research, medical conditions, etc.):
* Do you own or have access to a car?
* How far are you willing to travel to meet with your mentor?
* What is your preferred method of contact?
* What do you hope to gain from the Mentor Program?
* How important is it that your mentor is a member of your district?
* Would you consider attending a district meeting with your mentor?
* What is the most important criteria you are looking for in a mentor? (e.g., specialty, gender, ethnicity, location, practice setting, method of contact, etc.)