Mentor 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 mentor for the program please complete the form below. If you would like to take part in the program and receive mentoring, complete the form for mentees. 

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: EXPERIENCE - SCOPE OF WORK
SECTION 4: PERSONAL ATTRIBUTES OR INTERESTS

The following questions will help match mentors and mentees in relation to personal attributes and interests.

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

  • At least 5 years' experience as a consumer advocate
  • Familiarity with the role of the NPS Medicine Wise and its scope of work
  • Genuine interest in supporting and guiding consumers in their advocacy journey
  • High level communication skills and ability to build effective relationships
  • Willingness to be open and reflect on own personal attitudes and style
  • Ability to provide sound, independent feedback and advice

Desirable

Complete desirable criteria if applicable (approx. 100 words with 200 words maximum)

  • Previous experience as a mentor
  • Experience as a consumer advocate for NPS

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