Iowa White Coat Network Interest Form

As part of Operation I.O.W.A. (Innovative Opportunities for Workforce Action), the Iowa Medical Society is launching a pilot of the Iowa White Coat Network, a new mentorship initiative designed to connect medical students, residents, practicing physicians, and retired physicians across Iowa.

Participants will be matched based on shared interests, specialty, geography, career goals, and professional experiences using the Mentorloop platform, a proven mentoring tool used by organizations around the world.

The anticipated time commitment is:

- One hour during the first week

- 15-30 minutes per week thereafter

Please fill out this form to indicate your interest in being a part of a pilot program for the Iowa White Coat Network.

Fields marked with an * are required.

Full Name *

Phone Number *

Preferred Email *

Kind of participation *

Please indicate if you would like to be a mentor, mentee, or both.

Mentor

Mentee

Both

Iowa White Coat Network Interest Form

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Iowa Medical Society