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Samir Foundation Mentorship Application
Samir Foundation Mentorship application
Personell info
Full Name
Email
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Contact Number
Select Nationality
Select Country
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Select Time Zone
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GMT-12
GMT-11
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GMT-8
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GMT-7
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GMT+9
GMT+10
GMT+11
GMT+12
GMT+13
GMT+14
Profession
Doctor
Other healthcare professional
Other:
Speciality (if applicable)
Allergy and Immunology
Anesthesiology
Cardiology
Cardiothoracic Surgery
Child and Adolescent Psychiatry
Critical Care Medicine
Dermatology
Emergency Medicine
Endocrinology
Family Medicine
Gastroenterology
General Surgery
Geriatrics
Hematology
Infectious Disease
Internal Medicine
Nephrology
Neurology
Neurosurgery
Nuclear Medicine
Obstetrics and Gynecology (OB/GYN)
Occupational Medicine
Oncology
Ophthalmology
Orthopedic Surgery
Otolaryngology (ENT)
Palliative Medicine
Paediatrics
Plastic Surgery
Psychiatry
Pulmonary Medicine
Radiology
Rheumatology
Thoracic Surgery
Urology
Vascular Surgery
Other
If other:
Grade (if applicable)
Medical student (3rd year+)
Senior House Officer
Specialty Registrar
Consultant/Attending
Other
If other:
Preferred Mentorship Format
1:1 mentorship
Small group mentorship
Ad Hoc sessions/Q&A
Availability (hours per month)
1-2 hours
2-4 hours
5+ hours
Languages Spoken
English
Arabic
Other Languages (if applicable):
Motivation, experience and intention
What motivates you to mentor medical students from Gaza through the Samir Foundation?
Describe any previous mentoring, teaching, research or clinical supervision experience.
What specific topics, skills, or types of support can you offer mentees (e.g., clinical guidance, research, exam prep, career advice)?
Is there anything else you would like us to know about you, your background, or the support you wish to provide?
Would you be interested in other opportunities in the charity e.g. media, research or fundraising? What previous experiences do you have in this?
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