Become a Buddy

Become a Buddy
Tells us about your contact information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / 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 recipientI am a caregiverI am a living donorI 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?

YesNo
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?
What kind of communication would you prefer to have with your buddy?

Phone conversationVirtual Communication (ex. Zoom, Google Meets, Messenger calls)In-personWhatever they preferAll of the above
How often would you prefer to be in contact with your buddy?
Would you be ok with having more than one buddy?

YesNo
Do you have a preference of gender?

Yes, I would like my buddy to be the same gender as meNo, it doesn't matter
Preferred language
Tell us about your experience
Have you ever been a buddy/mentor in the past?

YesNo
If Yes, where?
Are you participating in any other buddy/mentorship program right now?

YesNo
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 understandNo, 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 understandNo, 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 understandNo, I do not understand
Signature
Should be Empty:

Become a Buddy

Tells us about your contact information

Tell us about your role in the transplant community

Tell us more about your interests in becoming a buddy

Tell us about your experience

Tell us a little bit more about you

Agreements