Become a Buddy
Tells us about your contact information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about the Buddy Program?
Tell us about your role in the transplant community
Please pick one:
I am a transplant recipient
I am a caregiver
I am a living donor
I am a donor family member
When did your love one pass away?
What did you donate?
What did you have transplanted?
When did you have your transplant? (You must be at least one year post to be qualified to join the Buddy Program)
If you had more than one, list the most recent one
Where did you have your transplant?
What is your diagnosis causing organ failure?
Do you volunteer with any other transplant organization?
Yes
No
If yes, what other organization do you volunteer with? (please list them all)
Tell us more about your interests in becoming a buddy
Who are you interested in being a buddy with?
Please Select
A recipient
A caregiver/family member
A living donor
A donor family
What kind of communication would you prefer to have with your buddy?
Phone conversation
Virtual Communication (ex. Zoom, Google Meets, Messenger calls)
In-person
Whatever they prefer
All of the above
How often would you prefer to be in contact with your buddy?
Please Select
Daily
Weekly
Monthly
once or twice a month
Whatever they need
I don't know
Would you be ok with having more than one buddy?
Yes
No
Do you have a preference of gender?
Yes, I would like my buddy to be the same gender as me
No, it doesn't matter
Preferred language
Tell us about your experience
Have you ever been a buddy/mentor in the past?
Yes
No
If Yes, where?
Are you participating in any other buddy/mentorship program right now?
Yes
No
If yes, where?
Tell us a little bit more about you
Why do you want to be a buddy?
Have you ever had a buddy/mentor for yourself in the past? If so, tell us about your experience.
If you are a transplant recipient, tell us about your journey.
Given your journey in the transplant community, how do you think you will be helpful to your buddy?
Agreements
I understand that becoming a Buddy in the Pre to Post Transplant Foundation's Buddy Program, I am solely responsible for providing guidance and support in my buddy's transplant experience and that I am in no way qualified to give any medical advice or diagnosis of any kind.
Yes, I understand
No, I do not understand
I understand that even though I apply to be a Buddy, it does not guarantee that I will be selected to be part of the program.
Yes, I understand
No, I do not understand
I understand that if I am selected as a Buddy, I will have to watch the training video and complete the training questions before I can begin my role as a Buddy.
Yes, I understand
No, I do not understand
Signature
Submit
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