Submission

APPD URiM Mentoring Map

Please use this form to submit mentoring programs in your institution, area or city that specifically serve under represented individuals looking to attend college or work in the STEM fields. The target age groups are elementary, middle school, high school, community college and undergraduate college. Although we are focused on mentorship for medicine based fields we are also interested in identifying programs geared for overall education based and job readiness mentorship.

Name(Required)

First Last

Email(Required)

Mentorship Program Name(Required)

Target Population(Required)

Program Type(Required)

Research internship

Clinical Shadowing

Big/Little Sibs

College Preparation

Career Exploration

Other, please indicate below:

Other Program Type (if not on list above)

Program Format(Required)

Program Duration (Year-long / Semester-long / Summer/6 weeks)(Required)

Program Cost(Required)

Program Website(Required)

FULL Physical Address (MUST include: Street Name and Number, City, State, Zip). If online only please note here "Online")(Required)

URiM Focus(Required)

APPD Region(Required)

If this program is in your department/area or you are offering individual mentoring, please offer a PROGRAM CONTACT

APPD URiM Mentoring Map

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