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MOM Mentor and Speaker Interest Form

Minority Ophthalmology Mentoring Mentor and Speaker Form

Thank you for your interest in becoming a mentor and/or speaker for the Minority Ophthalmology Mentoring program! This form takes 5 - 10 minutes to complete. You are able to save your information and return to it at a later date by clicking the option at the top right corner of the page. If you have any questions, visit or email

Mentors: At the heart of the program is a dynamic team of ophthalmologist mentors who guide underrepresented in medicine (UIM) students* on the path to becoming competitive ophthalmology residency applicants. Each mentor is matched one-on-one with a student whom they guide through medical school and, ideally, ophthalmology residency; therefore, mentorship is a commitment of several years. As a mentor, we ask that you:
  • Support your student's career development as they explore different areas of medicine
  • Demonstrate how ophthalmologists positively contribute to the healthcare community by preventing vision loss from diseases, such as diabetes and glaucoma
  • Illustrate how ophthalmologists help protect patients' valuable eyesight and how practicing ophthalmology is fulfilling to you personally
  • Communicate by phone, video chat, email or in person with your student 3 to 4 times each year, and more frequently when needed
This program has proven to be very popular among Academy members. If you are not matched with a student this year or selected to speak, your interest will be noted for subsequent years. 

Speakers: Through a competitive application process, the program introduces medical students to ophthalmology and guides them on their educational path. The goal of the program is to help underrepresented in medicine (UIM) students* become competitive ophthalmology residency applicants. As a speaker, we ask that you:
  • Learn about the Minority Ophthalmology Mentoring program so that you are comfortable speaking about it and answering questions
  • Promote the program to local UIM students and diversity officers at medical schools
  • Use our library of PowerPoints, flyers and other resources to speak about the many facets of ophthalmology and why you love being an ophthalmologist
We encourage speakers to schedule student engagement events between January and June. 

* Student Eligibility: For the purposes of this program, underrepresented in medicine (UIM) students include those who are Black, Hispanic and/or Native American (American Indian/Alaska Native/Native Hawaiian). We are seeking students who will be in their first year in an LCME or COCA accredited U.S. medical school during the 2023-24 academic year.