JC School of Public Health and Primary Care - Mentorship Programme

JC School of Public Health and Primary Care - Mentorship Programme - Mentee Application 2023

Participation in the mentorship programme is on voluntary basis and the partnership is based on mutual trust. The mentoring relationship will officially start in November 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 programme of the academic year in 2023-24. Both mentors and mentees will also be invited to attend the careers/ industrial seminars during the JCSPHPC Career Month in 2024.

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 B.Sc. in Community Health Practice B.Sc. in Gerontology B.Sc. in Public Health Master of Public Health Master of Science in Epidemiology and Biostatistics
Student ID
Year of Study (in 2023-24) 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
• 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 2023

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