A partnership between Patient & Community Partnership for Education in the Office of UBC Health and the community.
An e-mail will be sent to confirm your registration
*Required Inputs
First Name: *
Last Name: *
Preferred Name:
Phone #:*
E-mail: *
House Address: *
City: *
Province: * —Please choose an option—British ColumbiaAlbertaManitobaSaskatchewanOntarioQuebecNova ScotiaNew BrunswickNewfoundland and LabradorPrince Edward IslandNorthwest TerritoriesNunavutYukon
Postal Code: *
Program of Study: *
Year: * —Please choose an option—1st Year2nd Year3rd Year4th YearOther
Campus-Wide Login (CWL):*
UBC Student #:*
Please list any non-English languages that you speak fluently:
I have read the information sheet and I will commit to the program requirements.
Attendance at the Health Mentors orientation session is required to participate in the program. It will be held on September 25, 2023 (Monday) at 6:00pm - 8:00pm at the Croatian Cultural Centre. I can confirm my availability
Refreshments will be provided at the orientation session. Please indicate any dietary restrictions you may have:
We have recruited Health Mentors with a variety of conditions and their caregivers. If you have a particular preference (e.g. because a particular condition is especially relevant to your discipline), please indicate first, second and third preference by selecting 1, 2, and 3 beside each choice, or select “no preference”. Some mentors have several health problems: we have only listed the primary one here. Please note we cannot guarantee that you will be matched to your preference.
No Preference
First Preference: —Please choose an option—AsthmaCerebral palsyCrohn's diseaseDiabetesEpilepsyFibromyalgiaHIVMultiple sclerosisMultiple Lyme-diseaseMultiple LupusMultiple LymphedemaMental healthMovement disorders (e.g. Parkinson’s)Muscular dystrophyRheumatic diseases (e.g. arthritis)Spinal cord injury or disorderStroke/AphasiaTransplant
Second Preference: —Please choose an option—AsthmaCerebral palsyCrohn's diseaseDiabetesEpilepsyFibromyalgiaHIVMultiple sclerosisMultiple Lyme-diseaseMultiple LupusMultiple LymphedemaMental healthMovement disorders (e.g. Parkinson’s)Muscular dystrophyRheumatic diseases (e.g. arthritis)Spinal cord injury or disorderStroke/AphasiaTransplant
Third Preference: —Please choose an option—AsthmaCerebral palsyCrohn's diseaseDiabetesEpilepsyFibromyalgiaHIVMultiple sclerosisMultiple Lyme-diseaseMultiple LupusMultiple LymphedemaMental healthMovement disorders (e.g. Parkinson’s)Muscular dystrophyRheumatic diseases (e.g. arthritis)Spinal cord injury or disorderStroke/AphasiaTransplant
Most mentors have indicated that they are willing to travel for meetings. However, some meetings may take place in or near the mentor’s home. If you have a preferred location, please select first, second and third preference from the dropdown list or select No Preference.Please note we cannot guarantee that you will be matched to your preference.
First Preference: —Please choose an option—Vancouver (excl. downtown)Downtown VancouverNorth / West VancouverBurnaby / New WestminsterSurrey / DeltaCoquitlam / Port MoodyRichmond
Second Preference: —Please choose an option—Vancouver (excl. downtown)Downtown VancouverNorth / West VancouverBurnaby / New WestminsterSurrey / DeltaCoquitlam / Port MoodyRichmond
Third Preference: —Please choose an option—Vancouver (excl. downtown)Downtown VancouverNorth / West VancouverBurnaby / New WestminsterSurrey / DeltaCoquitlam / Port MoodyRichmond
Special Considerations:
Please indicate your preference for the format of group meetings. Please note we cannot guarantee that you will be matched to your preference.
No PreferenceIn PersonVirtual
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