Mentee application form

NPS MedicineWise and CHF are establishing a pilot Consumer Mentoring Program to help build the capacity and diversity of consumer representatives within the quality use of medicines sector. ​​​​​If you would like to be considered as a mentee for the program please complete the form below. If you would like to take part in the program as a mentor,  complete the mentor form. 

All expressions of interest will be assessed by panel consisting of a representative from CHF, NPS MedicineWise and two representatives from the NPS MedicineWise Consumer Advisory Group. If you have any questions please contact CHF Policy Officer Quality use of Medicines; Penelope Bergen at p.bergen@chf.org.au. Expressions of interest close at midnight on Thursday 31 Dec 2020. The information provided in your application form will be kept confidential and will only be shared with the selection panel.

SECTION 1: PERSONAL DETAILS & DEMOGRAPHICS
SECTION 2: REASONS FOR APPLYING (MAX 100 WORDS EACH)
Please provide 3 key reasons for applying to this program.
SECTION 3: PERSONAL ATTRIBUTES AND INTERESTS

The following questions will help match mentors and mentees in relation to needs and goals

SECTION 4: EXPERIENCE AND TRAINING AS A CONSUMER ADVOCATE
SECTION 5: RESPONSE TO THE FOLLOWING SELECTION CRITERIA (MAXIMUM 600 WORDS)

Please ensure you respond to all essential selection criteria (approx. 100 words per criteria, maximum 600 words in total for this section). 
 

Essential

  • Interested in developing advocacy skills and participating in a formal mentoring program
  • Meet one or more of the NPS priority areas: Which of the advisory groups are you willing to be considered for and why?
  • New to advocacy work or new to NPS or both
  • Willing to undertake advocacy work for NPS if successful
  • Willingness to be open, share information and receive constructive feedback

Desirable

Complete desirable criteria if applicable (200 words maximum)

  • Have completed training as a consumer advocate? (Please specify what training, who provided it and when you completed it)

SECTION 6: RELEVANT CHECKS

Must either have or be willing to obtain the following checks relevant to the mentoring program, if required:

  • Police and Criminal history
  • Working with Children
Maximum 250 words

SECTION 7: REFEREES

Please provide the names and contact details of two referees who would be willing to support your application.

REFEREE 1
REFEREE 2

THANK YOU FOR YOUR APPLICATION