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Faculty of Medicine and Health Sciences

MENTOR-MENTEE PROGRAM PERUBATAN

Year 1 (2003/2004 Session)
A. Personal Biodata:

1. Name: _________________________________________________________

2. IC No. (New): ______________________________________

3. Matric. No.: ________________________________________

4. Gender: ____________________________

5. Race: ______________________________

6. Religion: ___________________________

7a. Home Address: __________________________________________________

__________________________________________________

__________________________________________________

7b. Home Telephone No.: ____________________________________________

8. Present Address: _________________________________________________

_________________________________________________

_________________________________________________

9. Handphone No.:
_________________________________________________

B. Family Background:
1. Father’s Name: __________________________________________________

2. Father’s Occupation: _____________________________________________

3. Father’s Education (highest level): ___________________________________

4. Mother’s Name: _________________________________________________

5. Mother’s Occupation: ____________________________________________

6. Mother’s Education (highest level): __________________________________

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C. Your Educational Background:
1. What were your SPM results in the following subjects?

(a) English: _________ (b) Biology:_________ (c) Chemistry: _________

2. Did you enter UNIMAS via Matriculation or STPM? ___________________

3. If via STPM, what were your results in the following subjects?
(a) English: _________ (b) Biology:_________ (c) Chemistry: _________

4. What was your MUET score? ____________________

5. When filling in your UPU forms, what choice was UNIMAS?

(a) 1st: ____ (b) 2nd: ____ (c) 3rd: ____ (d) 4th: ____ (e) Not listed: ____

6. Which of the following factors influenced your choice of university?

(a) Family/relatives who studied at UNIMAS

(b) Friends already studying at UNIMAS

(c) My own personal choice

(d) No choice

(e) Selected by UPU

(f) Other factors (please specify) ___________________________________
_______________________________________________________________
_______________________________________________________________
6. When filling in your UPU forms, what choice was Medicine?
(a) 1st: ____ (b) 2nd: ____ (c) 3rd: ____ (d) 4th: ____ (e) Not listed: ____

7. Which of the following factors influenced your choice of program (Medicine)?

(a) Family/relatives

(b) Friends already studying Medicine

(c) My own personal choice

(d) It seemed like a suitable choice

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 (e) Other factors (please specify) ___________________________________
_______________________________________________________________
_______________________________________________________________

D. Problem Based Learning:

1. The Medical program at UNIMAS has been designed to emphasise Problem Based
Learning (PBL). Did you know this before selected the UNIMAS Medical program?

(a) Yes

(b) No

2. What do you know about the PBL system? __________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

3. What kinds of activities do you think will be expected of you in PBL sessions?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

4. What strategies do you plan to use at UNIMAS to become an excellent medical student?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________
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E. Course Registration for Semester 1, 2002/2003 Academic Session:

1. Have you registered for your Semester 1 core courses (i.e., MDP 10107, MDP
10207 and MDP 10702)?

(a) Yes

(b) Not yet

2. Have you registered for your Generic and Complementary courses?

(a) Yes

(b) Not yet

(c) If yes, for how many Credits? ________

3. Which courses?

(a) Generic courses: ___________________________________________

_________________________________________________________

_________________________________________________________

(b) Complementary courses: ____________________________________

_________________________________________________________

4. Total Semester 1 Credits = ____________________________

F. Meeting between Mentee and Mentor:

Mentor’s Comments: _________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Mentor’s Name: _________________________________________________

Mentor’s Signature: ______________________________________________

Mentee’s Signature: ______________________________________________