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1. PHYSICIAN PATHWAY PROGRAMS Planting the seeds for careers in medicine   Pathway programs are designed to provide guidance and support to students of all ages who are interested in pursuing careers in medicine. Programs include opportunities for middle school, high school, community college and undergraduate students.   SDCMS Health Pathways & Mentorship Opportunities: San Diego County Medical Society (SDCMS) is exploring ways to connect local physicians and healthcare professionals with students and to existing pathway programs throughout San Diego County and beyond.   Whether through career conversations, physician panels, mentorship, or other future opportunities, your experience can help students learn more about careers in medicine and see what may be possible for their own journey.   Complete this brief interest form to let us know how you might like to be involved. Submitting the form does not commit you to participate; it simply helps us better understand your interest as we continue developing the initiative.   Questions? Have an opportunity you'd like to share or know of another program we should include? Let us know. Call SDCMS at (858) 300–2787 or email Andrew.Gonzalez@ChampionsFH.org with any physician pathway inquires or suggestions.

2. ✽ REQUIRED FIELDS PRIVACY NOTICE: YOUR PRIVACY IS VERY IMPORTANT TO US. THEREFORE, SDCMS DOES NOT SHARE OR DISSEMINATE ANY INFORMATION SUBMITTED WITH ANY OUTSIDE PARTY, ORGANIZATION, COMPANY, OR INDIVIDUAL. SDCMS Member?
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3. First Name ✽

4. Last Name ✽

5. Email Address ✽

6. Mobile Phone ✽

7. Medical License Number ✽

8. Primary Specialty ✽

9. Practice / Organization

10. Career Stage
Undergraduate Medical Education Postgraduate Training Practicing Clinician Retired/Non-Practicing Clinician Other (please specify):

10.1.

10.2.

11. How You'd Like to Support Pathways [CHECK ALL THAT APPLY]
Speaking to a class or student group about my career Participating in a professional career panel Sharing information about my medical specialty Supporting or mentoring students if future opportunities are developed Helping to shape the Physician Pathways initiative Participating in occasional pathway events Staying informed about future opportunities All of the above Other (please specify):

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