At the end of your mentorship program, you are required to submit a report on your experience. In part, this report may be used in the ISD Connection Newsletter or on ISD social media.

Please be sure to attach 2-3 photos from your program as jpg or png files.

Mentee Information

First Name *
Last Name *
Country *
Institution *

Mentor Information

First Name *
Last Name *
Country *
Institution *

Program Description

Duration *
Major goals for your mentorship experience: *
(Maximum characters: 500)
You have characters left.
What did you like best about your mentorship experience? *
(Maximum characters: 500)
You have characters left.
Describe any special experiences with your mentor *
(Maximum characters: 500)
You have characters left.
Describe a skill acquired during your mentorship that you will definitely use when you return home:
(Maximum characters: 500)
You have characters left.
How will your mentorship experience impact your patient care and professional goals over the next year? *
(Maximum characters: 500)
You have characters left.
How will your mentorship experience make an impact five years from now, including for your region or country? *
(Maximum characters: 500)
You have characters left.
Share a pearl you learned during your mentorship experience: *
(Maximum characters: 500)
You have characters left.

Upload photos from your mentorship program. Be sure to include candid "action shots" as well as one of you and your mentor. 

Photo1
Photo2
Photo3



void

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Contact Us

+32 (0)2 227 27 42
isdsecretariat@thetriumph.com

Connect With Us

2024 International Society of Dermatology. All Rights Reserved.