2023校友業師諮詢申請表 (Student Application for Alumni Mentorship Program)

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親愛的同學，您好：

請在4/21(五)前填寫以下個人基本資料，並從業師名單中選出3位業師(其中2位為備案)，本院將依優先順序詢問業師意願，待媒合成功再個別通知同學。由於多數業師工作繁忙，若多位同學申請同一位業師，可能會依優先順序媒合。感謝您的配合。

臺大公衛學院敬啟
02-3366-8200

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Dear students,

Please fill out the following personal information, select and prioritize 3 mentors from the Mentor List by Fri Apr 21st. Matching will be made in the order of your selection of 3 prioritized mentors. The NTUCPH Office will notify you through email when you are matched. If a mentor is selected by more than one student, the mentor will be matched with the student who marks the mentor in the first priority. Thank you for your cooperation.

Best regards,

College of Public Health
National Taiwan University
Email: phc@ntu.edu.tw

姓名 (Name) *

學號 (Student ID) *

就讀系所 (Department/Institute) *

公衛系 (Department of Public Health)

環職所 (Institute of Environmental and Occupational Health Sciences)

流預所 (Institute of Epidemiology and Preventive Medicine)

健管所 (Institute of Health Policy and Management)

行社所 (Institute of Health Behaviors and Community Sciences)

食安所 (Institute of Food Safety and Health)

公衛碩士學位學程 (MS in Public Health, MPH)

全球衛生學位學程 (MS/PhD in Global Health, GHP)

常用Email (Frequently Used Email Address) *

聯絡電話 (Phone Number) *

業師1 (Mentor 1) *

「業師1」代表您這次最希望優先諮詢的業師。("Mentor 1" refers to the mentor you would like to consult with in the first priority this time.)

業師2 (Mentor 2)

若「業師1」無法提供諮詢，將改詢問「業師2」的意願。(If Mentor 1 is not available for this mentoring, Mentor 2 will be matched.)

業師3 (Mentor 3)

若「業師2」無法提供諮詢，將改詢問「業師3」的意願。(If Mentor 2 is not available for this mentoring, Mentor 3 will be matched.)

希望諮詢的問題 (Questions you would like to consult with the mentor) *

請盡量詳述，讓忙碌的業師能先了解同學欲諮詢的面向，進而評估如何或是否適合提供協助。若欲諮詢的問題因業師而異，可依上述3位業師分別詳述。(Please describe your questions in detail for the mentors to understand what you want to consult with and to assess how/whether they can provide assistance. You may list the questions respectively for each mentor.)

若有任何問題與想法，請留言。(Feel free to leave a message if you have any question or concern.)

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