JC School of Public Health and Primary Care - Mentorship Programme

JC School of Public Health and Primary Care - Mentorship Programme - Mentee Application

Participation in the mentorship program is on voluntary basis and the partnership is based on mutual trust. The mentoring relationship will officially start in October and end in July (of the next year). Mentors and mentees are encouraged to meet up at least 4 times throughout the programme.

Opening Mixer will be held to kick start the mentorship program of the academic year in 2021-22. Both mentors and mentees will also be invited to attend the careers/ industrial seminars during the JCSPHPC Career Month in February/ March 2022.

A. Personal information
Salutation *

Salutation Dr. Mr. Mrs. Ms.
Name (English) Name (English) * First Last
Preferred Name
Name (Chinese)
Gender *

Gender Female Male
Mobile Phone No. (to be released to your Mentor only) *
Email *
B. Programme Information
Programme *

Programme BSc in Community Health Practice BSc in Public Health Master of Public Health Master of Science in Epidemiology and Biostatistics
Student ID *
Year of Study (in 2021-22) for BSc students only
Concentration (MPH students)
C. Your preference for the Mentors

Please prioritize your career interests
1. By job nature (1 = Highest interest and 3 = Lowest interest)
1st Priority *
2nd Priority *
3rd Priority *
2. By employer (1 = Highest interest and 3 = Lowest interest)
1st Priority *
2nd Priority *
3rd Priority *
3. By subject for further study (1 = Highest interest and 3 = Lowest interest)
1st Priority *
2nd Priority *
3rd Priority *
Additional interested subject(s) and priority (optional)
Expectation *

Expectation Useful feedback and industry trends Networking Career Progression Personal Development Learn to Mentor Others Sharing Successful Cases Other Other
Similar Experience (BSc students)
If you have participated in the Mentorship Programme before or if you have internship experience, you can indicate your mentor or supervisor below and assignment of the same person as your mentor will be avoided.
D. Your Hobby
Please fill in your hobby for mentor matching *

Please fill in your hobby for mentor matching Charity Work Music Travelling Reading Sports Computer/TV Game Other Other
E: Your Contribution

You are cordially invited to contribute your talent to this Mentorship Programme to make it more fruitful.
Main areas of contribution needed:
i. Master of Ceremony (MC) ~ A few meetings and a rehearsal before the Inauguration Ceremony are required. Estimated additional time commitment: 6 hours
ii. Administrative or logistic support ~ Estimated additional time commitment: Negotiable
Are you interested in making a contribution to this Mentorship Programme? *

Are you interested in making a contribution to this Mentorship Programme? Yes, I am interested. No, I am NOT interested.
Please prioritize your area of interest. (1 = Highest priority and 2 = Lowest priority)
1st Priority
2nd Priority
Other (Please specific)
F. A brief introduction of yourself
within 100 words *
Declaration
Terms of Application *

Terms of Application 1) I have applied with my true identity and all the information provided is true. 2) I understand that if I fail to complete this Mentorship Programme after successful application without prior notification and sound reason(s) may have negative implication on future registration for opportunities offered by the JC School of Public Health and Primary Care.3) I understand that only the latest submission to this form is valid if multiple submissions are received from the same applicant.
• I would like to confirm my acceptance as a Mentee for the Mentorship Programme for this year.
• I agree to take a proactive approach to maintain the relationship, and be prepared to contribute to the setting of objectives for the relationship and subsequent individual meetings with my mentor.
• I confirm that the information given below is true and complete and I understand that the information will be kept in strict confidence by the JC School of Public Health and Primary Care and the relevant staff. *

Draw or Type

I understand this is a legal representation of my signature.
Remarks: The personal data provided on this form will be used solely for the operation of mentorship programme.
Thank you for your support! Clear

Full Name

I understand this is a legal representation of my signature.
Remarks: The personal data provided on this form will be used solely for the operation of mentorship programme.
Thank you for your support!
Date Date / MM / DD YYYY
Disclaimer The personal data collected will be used by The Jockey Club School of Public Health and Primary Care - Admin Office (SPHPC_ADM) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

JC School of Public Health and Primary Care - Mentorship Programme - Mentee Application

A. Personal information

B. Programme Information

C. Your preference for the Mentors

D. Your Hobby

E: Your Contribution

F. A brief introduction of yourself

Declaration