Mentee Form

The following will help us try to match junior toxicologists with senior toxicologists. We will do our best to match toxicologists with similar interests however we may be limited by the availability of volunteers.

Name*
First Last
Email*
Geographic Location*
City State / Province / Region Country
Requesting a mentor for
- Assistance/mentorship with a short term project
- Long term mentorship
Desired area of expertise of the mentor
- Academia
- Addiction medicine
- General toxicology
- Litigation/consulting
- Pediatrics
- Poison center
- Research
- Other
Other desired area of expertise of the mentor:
Specialty
Please note any specifics you would like to get out of this program.
If you have the option to attend NACCT in-person, will you attend?
- Yes
- No
- Undecided

Mentee Form

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