VTP Mentor Volunteer

By volunteering as a mentor in the ASH Visitor Training Program (VTP), you will host program participants for up to 12 weeks at your institution. In order to serve as a mentor, you must be an ASH member in good standing (anywhere in the world) who can assume the responsibilities of overseeing the participant's work and progress. Mentors are needed for physicians as well as laboratory scientists. Volunteering to host does not guarantee that a trainee will be assigned to you. Applicants will be paired with the most suitable host mentor available each year.

*Please note that completion of this form is not a commitment to serve. If paired with a candidate, you will have the option to participate or refuse to participate once you have reviewed the candidate's training proposal.

Contact Information
First Name*
Middle Initial
Last Name*
ASH Member Number*
Degree(s)*
Institution*
Title*
Institution Physical Address*
City/Town*
State/Province*
If Other, please specify
Country*
Zip Code/Postal Code*
Phone Number*
Email Address*
Expertise and Experience
VTP participants receive up to 12 weeks of targeted training in specific issue areas. The list below reflects the most common training topics requested from VTP candidates. Please select the topics below for which you are able to provide training. (Please consider the frequency of relevant tests performed and patients seen at your home institution within a 12 week period when determining which topics you are able to cover).*
Bone marrow transplantation/stem cell transplantation
Basic morphology
Flow cytometry and molecular biology
Hemaglobinopathies
Thrombosis and hemostasis
Transfusion medicine
Other
If Other, please specify*
Hematologist Type*
What best describes you?*
Related to your specialization, which disorders do you treat most frequently? (Please be as specific as possible)*

Remaining 500 words out of 500
Host mentors must upload a bio-sketch or their most recent curriculum vitae in order to be considered. This document must not be greater than three pages in length (template, example, and instructions for the NIH bio-sketch format can be found in the resources tab on the right side of this page). *