UERM Memorial Medical Center Alumni Foundation USA, Inc.

UERM AFUSA Student Videoconference Disclaimer and Consent Form

Confidentiality & Conduct

I agree to maintain confidentiality, behave professionally, and not record or distribute sessions without permission.

Limitations

Advice is based on experience and does not constitute formal academic, legal, or licensing guidance. I remain responsible for my decisions.

Technical & Data Use

Sessions occur via virtual platforms. The program is not responsible for technical issues. Feedback is anonymized for program evaluation.

Purpose
I voluntarily participate in the UERM AFUSA Program, which provides mentorship, wellness support, career guidance, and optional clinical enrichment through virtual sessions with alumni physicians.

Nature of Sessions
Sessions may include mentorship, USMLE/residency guidance, CV/research advice, and optional clinical discussions. These are informal, non-credit, and supplementary to the UERM curriculum.

Acknowledgments

  • Participation is voluntary and may be withdrawn at any time without consequence
  • No academic credit, grading, or formal evaluation is provided
  • Alumni mentors act in a non-faculty, advisory role

Consent
I have read and understood this form and agree to participate.

Clear Signature

Alumni–Student Mentorship, Career Development, and Clinical Enrichment Program (Pilot Phase)