Alumni/Student Interaction Project

I am interested in participating

I am not interested in participating. Please list reasons:

I can mentor/advise a medical student or have a student shadow or work with me (check preference):
Summer (June/July)
One Day
One week
Other

I can pay a student for summer internship (a typical internship pays $2,208 for 8 weeks )
Spring Break (1 week in March)
One day;
Five Days;
Other; No. of days

During School Year (August-May):
1-3 days a week
1-3 days a month
other

1-2 weeks a month
1-2 weeks a year
other

1 month a year

I would be willing to take more than one student (how many )

I would like to speak to students at the SOM VA Campus about my specialty, day-to-day routine, lifestyle, etc.

Other involvement:

I can provide housing for a student.

A medical student can contact me to set up a schedule.

I would prefer

First-year students

Second-year students

Third-year students

Fourth-year students

Hosting Opportunities (for residency interviewing or fourth year away electives ):

I could show a student around town.
I could take a student out for dinner.
I could offer housing for 1-2 nights in my home
I could offer housing during the entire away elective rotation

Special Medicine Interests:

Hobbies Outside Medicine:

Other Comments/Suggestions:

Physician Name:

Gender:

Specialty:          Grad Year:
Sub-Specialty:

Address:

City:   State     Zip  

Daytime phone: Fax:

Email:

Contact name & number if different from above:

Is this a new or updated profile?    New    Updated

Please submit form by clicking on submit above or fax to 803-733-3335 or mail to:
Debbie Truluck        Questions
Alumni Office, Bldg.28        Phone: 803-733-1568
USC School of Medicine        truluck@med.sc.edu
Columbia, SC 29208