🎓 Training form — Muslim Healthcare Network

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Become a member

Training and Development

💼 Mentorship form

🎓 Training form

Resource Center

Chaplaincy and Hospice

Business Directory

Folder: Membership

Become a member

Folder: Training and Development

💼 Mentorship form

🎓 Training form

Folder: Resource Center

Chaplaincy and Hospice

Business Directory

Training Form

Please provide the information to join our trainees pool

By submitting the form, you are giving the Muslim Healthcare Network team the permission to contact you, email you, and to share your information with interested individuals

Disclaimer: Muslim Healthcare Network does not offer visa sponsorship at this time. Currently, we are only matching mentees with mentors within the Ohio area. Applicants from outside Ohio will be subject to a $100 processing fee.

Name *

First Name

Last Name

Degree(s) *

Email *

Phone Number *

(###)

###

####

Work Phone Number

(###)

###

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Profession you seek mentorship in *

Physician

Pharmacist

Nurse

Allied heath Professional

Administration

Other

please specify

Specialty *

Organization Name

Type of Mentorship you are seeking *

Career Advise and Guidance

Clinical Rotation (Observation)

Clinical Rotation (Hand on)

Clinical Research Opportunity

Laboratory Research Opportunity

Other

Please specify

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Dropdown

Visa Status

Please specify

Specific dates required

Specialty rotation required

Specify State/ Healthcare system, if any

Thank you!

Muslim Healthcare Network

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