Mentee Form

MENTEE PROGRAM

Thank you for your interest in the WMGMA Mentee Program. Each year's class is limited to 5 Mentor/Mentee pairs. This peer learning program is open to anyone feels they can benefit from someone who may have more experience, whether in medical group management generally or a specific aspect of management.

Mentors will be matched with Mentees based on a variety of demographics, including: special areas of interest, geography, practice setting, job title/responsibilities or ACMPE Domains.

Mentor/Mentee Relationship
The goal of the Mentor program is a mutual peer/leadership experience. We would like pairs to schedule up to four one-hour meetings throughout the year, either by phone or in-person and be available for a meeting at the Mentor Program Reception held during the WMGMA Annual Conference.

 

Your Name: *
Your Email: *
Are you a WMGMA Member?:
Yes
No
Practice Setting:
Single-specialty
Multi-specialty
Academic
Private Practice
Title/Job Responsibilities:
ACMPE Domains (Check all that apply):
Operations Management
Financial Management
Human Resource Management
Risk and Compliance Management
Patient-Centered Care
Organizational Governance
Tell us how being a part of the Mentorship program could help you: *
What areas of Medical Group Management would be useful to learn more about?: *


MENTEE PROGRAM

Thank you for your interest in the WMGMA Mentee Program. Each year's class is limited to 5 Mentor/Mentee pairs. This peer learning program is open to anyone feels they can benefit from someone who may have more experience, whether in medical group management generally or a specific aspect of management.

Mentors will be matched with Mentees based on a variety of demographics, including: special areas of interest, geography, practice setting, job title/responsibilities or ACMPE Domains.