TOPNOTCH MEDICAL BOARD PREP STUDENT PROFILE FOR MENTORING

For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchboardprep@yahoo.com

Name: Nickname: Age :
Religion: Province:
Civil Status: Number of kid/s:
Medical School: Date of Graduation:
Intership Program
Contact Number/s: Email: PHOTO
GLOBE- _____________________
SMART-_____________________ (2 X 2)
SUN- _____________________

PREFERRED MENTOR:

Percentile Ranking:  Upper 25%  Middle 50%%  Lower 25%

First Time Boards Taker?  YES  NO

If No, how many previous attempts?____

PLEASE ANSWER AS TRUTHFULLY AS POSSIBLE:

1. What is your goal for this year’s Boards?

 TOP THE BOARDS  PASS THE BOARDS Partnership Agreement
Learning Contract
2. What are the distractions do you think would hinder you from your goal?
A.____________________________________________________________ As mentor and mentee in the Topnotch Mentoring
B.____________________________________________________________ Program, we agree to abide by the following:
C.____________________________________________________________ 1. Commit to making the time to communicate
D.____________________________________________________________ with each other on a regular basis.
2. Keep the content of our conversations
3. What are the strengths do you think would help you achieve your goal? confidential
A.____________________________________________________________ 3. Practice active listening
B.____________________________________________________________ 4. Provide each other with honest, direct and
C.____________________________________________________________ respectful feedback.
D.____________________________________________________________ 5. respect the Mentor to Mentee relationship.

4. What are your expectations from your Mentor? Date:

As a counselor: ________________________________________________
As a motivator:________________________________________________ Mentee
As a role model: _______________________________________________ (Siganature)
Others: ______________________________________________________
( e.g. To help me cope with my breakup; To cheer me up whem I’m down, etc)

I expect my mentor to be ___ involved in my preparations Mentor

 actively (Signature)
 sufficiently (just right)

5. Do you study best:

 alone  with a group
 at home  at a coffee shop  others:___________

6. What is your planned study arrangement?

 stay at home group study

 bunk with others  co-working space
 study on my own  library
 live outside home (self)  others:_____________________

7. Do you encounter any of these problems? (Check all that apply)

 Get distracted easily mostly by _________________________________  Easily influenced by peers (drinking, road trips)
 Have problems memorizing  Currently moonlighting or with part time job
 Get easily discouraged  Obligation to children
 Prone to cramming  Gets “paralyzed by fear”
 Suffer from poor time management  Luck motivation
 Frequently tardy  Financial difficulties
 Always sleepy  Travel plans outside Manila
 Have emotional fluctuations  Inconsistent study habits
 Have relationship issues (spouse, boy/girlfriend)  Self esteem issues
 Mandatory religious obligations  Mandatory family obligations
 Existing medical or psychiatric condition (please specify:____________)  Others:_______________________________
 Still having make up duty until:_________________________________

TOPNOTCH MEDICAL BOARD PREP STUDENT PROFILE FOR MENTORING

For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchboardprep@yahoo.com