GLODERM Mentee Application Form

Thank you for your interest in joining the GLODERM Mentorship Programme!

The Programme is a cornerstone of GLODERM’s sustainable and integrated approach to improving dermatologic clinical care, education, research, policy, and advocacy. The programme brings together Mentor-Mentee Pairs from all over the world to share knowledge and grow the skills needed for Mentees to become ‘change-makers’. This Programme is not aimed at providing specialty training for clinical skills, it is focused on developing leadership, project management, and changemaker expertise.

Before applying, please review the following application requirements carefully:

✅ Complete Application Form

Applicants can review questions within this application, automatically save any responses, and return to submit them as needed. You may wish to write your answers in a separate document in advance, and then copy and paste into the relevant application boxes.

✅ Letter of Consent

Applicants must provide a written letter of consent from their institution that includes the following:

The letter must be dated and signed or stamped on official institutional letterhead.
The letter must confirm permission for the applicant to attend the following in-person events:

GLODERM Leadership Development Retreat - Moshi, Tanzania, January 2027 (exact dates TBC).

World Congress of Dermatology - Guadalajara, Mexico, 21-26 June 2027.

The letter must be signed by a senior colleague or an authorised representative from your institution.

For applicants conducting a project in the public sector but are privately employed or self-employed:

The letter must confirm permission to attend both events.
The letter must be written by a peer in a similar or senior administrative role (not self-written).

If you have any questions, please contact info@gloderm.org

⏰ The deadline to submit an application is 4:00PM BST on Friday 8 May 2026

Introduction

Please watch this guidance video from Dr Esther Freeman, Past-Chair of GLODERM, and Founder of the GLODERM Mentorship Programme.

Eligibility

Please complete and confirm the following information:

To join the GLODERM Mentorship Programme, you must be on an eligible dermatology pathway.

Eligible pathways include:
✔️ Physician (including MMed, MBBS, MD or equivalent) working on a global health dermatology project;

✔️ Individuals in the final years of recognised dermatology training pathway, including dermatology diplomas;
✔️ Practicing dermatologists looking to develop expertise in global health dermatology, including early-stage specialist dermatology providers and career switchers. Must be within five (5) years of completing their dermatology training.
❌ This programme is not for medical students.

I confirm that I am on an eligible dermatology pathway

Yes

If you do not meet the eligibility as stated above, unfortunately we will not be able to accept your application.

Confirmation of understanding

Please tick all the boxes below to confirm your understanding of the requirements of this programme.

I understand that this is not a programme for developing clinical skills.

Yes

I understand that this is a 12-month virtual programme and that if selected I can meet this time commitment of monthly virtual meetings, regular sessions with my mentor and an in-person training.

Yes

I understand and acknowledge that I will be required to travel internationally to attend the GLODERM Leadership Development Retreat in Moshi, Tanzania for one-week in January 2027.

Yes

I understand and acknowledge that I will be required to travel internationally to attend the World Congress of Dermatology in Guadalajara, Mexico from 21-26 June 2027.

Yes

I understand that failure to complete the programme will require me to return all the financial support I have received.

Yes

I confirm that I work in the public sector or conduct a project in the public sector or in underserved communities/global health dermatology.

Yes

I confirm that I live or work in resource-limited settings. (Exceptions may be made for those in high-income countries if they work with underserved populations, such as indigenous or native communities).

Yes

I will undertake GLODERM monitoring, and evaluation activities as required. This may include written reports, interviews, and video recordings.

Yes

Letter of Consent

Please upload a letter of consent.

Applicants are required to submit a written letter of consent from their institution.

The letter must include the following:

1. The letter must be dated and signed or stamped on official institutional letterhead.
2. Approval to attend the following in-person events:

GLODERM Leadership Development Retreat - Moshi, Tanzania (one-week in January 2027).
World Congress of Dermatology - Guadalajara, Mexico (21-26 June 2027).

3. The letter must be signed by a senior colleague or an authorised institutional representative.
4. Please ensure the letter is written in English, where possible.

For applicants conducting a project in the public sector but who are privately employed or self-employed, the letter must confirm permission to attend both events in-person and be written by a peer in a similar or senior administrative role. The letter cannot be self-written.

Note: Applications without a valid letter of consent will not be considered.

To begin, we would like to hear about your academic and professional background.

This section covers the essential details, including your contact information to update you on the outcome of your submission.

Your details

Your First Name

Your Last Name

Your Email Address

Your Gender

In which country do you primarily live and work?

With which institution(s) are you affiliated?

Please select the appropriate category for these affiliations:

You selected 'Other', please share more details

What is your current job title / role within this institute?

Your experience

What is your level of dermatology experience?

If you select ‘dermatology residency’, please keep in mind this is referring to a dermatology residency specifically for physicians, e.g. MD or MMED qualifications or similar - NOT clinical officers or nurses

You have selected "Dermatology residency (in progress)" above - please confirm your current year in residency e.g. 1st year, 2nd year etc. PLEASE ANSWER WITH A NUMBER ONLY (1 / 2 / 3 etc.)

You have selected "Dermatology residency (in progress)" above - please confirm what year you will graduate from your residency programme e.g. 2027, 2028 etc. PLEASE ANSWER WITH A NUMBER ONLY (YYYY)

You have selected "Dermatology residency (completed)" above - please confirm what year you graduated from/completed your residency programme. PLEASE ANSWER WITH A NUMBER ONLY (YYYY)

You have selected "Informal training" or "Other" above - please share more details on what experience you have, including any year/dates related to any training completed.

Please state any relevant diplomas, certificates, and educational degrees below

Please list any scientific publications that you have been involved in (3 maximum)

This section gives you the opportunity to tell us more about yourself and why you want to become a GLODERM Mentee.

Why are you interested in global health dermatology and joining the GLODERM Mentorship Programme?

Maximum 200 words

What are the top 3 skills in global health dermatology that you wish to gain from this Mentorship Programme and why?

Maximum 300 words. Some examples are: writing publications, conducting peer reviews, writing grant and funding proposals, setting up training projects, building community outreach educational projects, policy design and implementation, leadership skills, public speaking, and strategic partnership development

Please select 3 sub-specialities of global health dermatology that you are interested in learning about within this Mentorship Programme (select up to 3 choices by holding the Control key)

Motivation

Look into your crystal ball... and tell us about the future. This section is all about what makes you different.

Why should you be part of this Mentorship Programme, and how will you improve future skin health care in your community and beyond?

Maximum 300 words

Leadership experience

Being a visionary, but also being flexible, humble, creative, and collaborative are important personal traits in becoming a global health dermatology leader.

Can you give an example of a time where you demonstrated leadership in at least one of these ways? Please be as specific as possible.

Maximum 300 words

Programmes & projects

Is there a dermatology focused public health gap, problem in your community, or project you are working on that you wish to address or have already started working on?

Maximum 300 words. Please be as specific as possible with concrete steps regarding how you would progress or undertake your project/programme proposal.

Implementation

How will you implement what you learn from the Mentorship Programme to create sustainable change for your community or project in the future?

Maximum 300 words. For example, based on your own leadership skills and ambitions, relevant experience and interest in global health dermatology, creating change and impact in your community.

Confirmation

Please confirm the statement below and then submit your application.

I can confirm that the information I have submitted in this application form is accurate and true to the best of my knowledge.

Yes