Medical Student and Resident Mentor Application

We accept medical students and residents into the mentoring program throughout the year.

MEDICAL STUDENT AND RESIDENT PROGRAM FRAMEWORK

The CPL medical student and resident mentoring program provides resources through the learning platform, yearly conference and regular interaction with CPL member physicians.

Full Name *

Prefix First Name Last Name

Please read: Canadian Physicians for Life Statement of Principles *

I agree with Canadian Physicians for Life’s Statement of Principles. *CPL members donate funds to facilitate the mentoring of medical students. I am not in agreement with Canadian Physicians for Life’s Statement of Principles.

Medical School

Grad Year

Sex *

Male Female

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

How did you hear about CPL’s Medical Student and Resident Mentoring Program? *

Have you ever attended one of Canadian Physicians for Life’s conferences in the past? *

Yes No

If so, what did you find most valuable from the experience?

What are you hoping to gain from the mentoring program?