International Women in Multiple Sclerosis (iWiMS) Mentorship Survey

First Name *

Last Name *

Phone Number *

Email Address *

Country *

Job Title *

Which language(s) do you speak? *

What is your current career level? *

What type of practice are you currently working in? *

Are you involved in research? *

Yes, Clinical

Yes, Lab

Yes, Both Clinical and Lab

No

In what capacity would you like to be involved in the mentorship program? *

Mentor (support a Mentee through career choices, salary negotiation, career advancement, leadership development, etc.)

Mentee (be paired with a more experienced Mentor who can help guide you in career choices, etc,)

Peer (Mentor level/partnership or small group formation in order to give/offer support for career advancement, i.e. letters of support for promotion, research collaboration, etc.)

What are the primary goals for your involvement in this mentoring/peer support group? *