CCMS Medical Student
Summer Mentorship Program

June - August, 2019


Sponsored by:


Clark County Medical Society’s Summer Mentorship Program aspires to enrich the education of first and second year medical students in Southern Nevada by matching them with a practicing physician mentor during the summer. The program offers students early clinical exposure and a personal relationship with a practicing physician, while giving physician members of CCMS the opportunity to share their wisdom and experience with the next generation of health care leaders to prepare them to practice here in Nevada.


Student Mentee Application

Name *
Cell Phone *
Cell Phone
1. Are you a member of CCMS? *
2. The program commitment is a total of 4-12 hours, do you agree to those terms? *
3. Do you require any special accommodations (e.g. wheelchair access, allergies, etc.)? *
Have you worked alongside a physician before? *
Have you participated in a mentorship program before? *

To complete your application, please submit your letter of good standing and unofficial transcript to


 Physician Mentor Application

Name *
Cell Number *
Cell Number
Office Number *
Office Number
Preferred Contact *
Do you prefer a long term or short term relationship? *
Practice Type *
Check all that apply
Available for... *
Check all that apply