Asians in Recovery Mentor Application

Full Name* This field is required.

First Name

Last Name

Preferred Pronouns* This field is required.

Email Address* This field is required.

example@example.com

Confirm Email

Phone Number* This field is required.

Please enter a valid phone number.

ZIP Code* This field is required.

Age Range* This field is required.At this time, Asians in Recovery (AIR) is accepting mentor applicants aged 18 and older.

Ethnic Background / Nationality* This field is required.(Select all that apply)

American Indian or Alaska Native

Asian Indian

Bangladeshi

Black or African American

Burmese

Cambodian (Khmer)

Chinese

Filipino

Hispanic, Latino, or Spanish Origin

Hmong

Indonesian

Japanese

Korean

Laotian

Malaysian

Nepali

Pakistani

Samoan, Native Hawaiian, or Other Pacific Islander

Sri Lankan

Taiwanese

Thai

Vietnamese

White (e.g., European, Middle Eastern, North African)

Other

Languages Spoken at Home* This field is required.(Select all that apply)

Arabic

Bengali

Cantonese (Chinese)

Chinese (Unspecified dialect)

English

French

German

Gujarati

Hindi

Hmong

Japanese

Korean

Mandarin (Chinese)

Nepali

Polish

Portuguese

Punjabi

Russian

Spanish

Tagalog (Filipino)

Tamil

Thai

Urdu

Vietnamese

Other

What is your primary motivation for becoming an AIR Mentor?* This field is required.(Select one)

To give back and support others going through a similar recovery journey.

To help increase Asian representation and break the stigma associated with recovery.

To gain leadership skills and grow professionally through mentoring.

To foster a sense of community and connection among Asian individuals in recovery.

Which area of mentorship are you most excited to focus on?* This field is required.(Select all that apply)

Sharing personal recovery strategies and coping skills (e.g., managing cravings, identifying triggers, self-care routines).

Navigating family expectations and cultural challenges while in recovery.

Building healthy self-advocacy and setting boundaries in personal and social life.

Discussing the unique experience of being an Asian person in recovery (i.g., reducing isolation, finding community).

Supporting early recovery fundamentals (e.g., finding meetings, establishing a support network).

Please summarize your desire to join in a few sentences. * This field is required. (In your response, tell us what makes you feel uniquely ready for this role.)

How long have you been in recovery or sober?* This field is required.

Do you participate in a 12-Step or similar mutual-aid program?* This field is required.

Yes

Prefer not to answer

If yes, Which program(s) do you participate in? (e.g., AA, NA, Smart Recovery, LifeRing, etc.)

Do you have any certifications, trainings, or related experience in mental health, recovery, or peer support?

Approximately how many total hours per week can you dedicate to mentoring (including meetings, texts, and emails)?* This field is required.(Note: Mentors in our program typically commit between 2 and 4 hours per week.)

What is your preferred way to connect with your mentee? * This field is required.(Note: Mentors are required to hold one weekly meeting (45–60 mins), plus communicate in between via text/email as needed.) (Select all that apply for both the weekly meeting and in-between communication)

Video Call (Zoom, Google Meet, etc.)

Phone Call

Text/Messaging App (WhatsApp, Signal, etc.)

In-Person Meeting (May be limited by location.)

Would you prefer to mentor someone of the same:* This field is required.

How did you hear about Asians in Recovery (AIR)?

Friend or relative

Social media

Online search

Workshop/Event

Community organization

Other

Stay Connected* This field is required.Would you like to join the Asians in Recovery newsletter for updates and community news?

YESNO

Terms and Conditions* This field is required.AIR Mentor Program: Terms of Participation & Data Consent By submitting this application, you acknowledge and agree to the following terms regarding your participation in the AIR Mentor program. 1. Data Collection and Usage We collect the personal and demographic information provided in this survey, including your name, contact details, identity, ethnicity, and recovery experience, for the sole purpose of running the AIR Mentor program. Matching: Your responses (e.g., gender, ethnicity, languages, experience level) will be used by AIR staff to confidently match you with a compatible mentee. Program Improvement: Aggregate, anonymized data (data that cannot be traced back to you) may be used for internal reporting, grant applications, and to improve the effectiveness of the program. Confidentiality: Your individual, identifying data will never be shared publicly or sold to third parties. 2. Commitment to Confidentiality As a program rooted in recovery, confidentiality is paramount. AIR Staff: All AIR staff and volunteers who handle application data are bound by strict confidentiality agreements. Mentor/Mentee Relationship: If accepted into the program, you will be required to sign an agreement committing to the complete confidentiality of all personal information shared by your mentee. 3. Program Roles and Expectations No Guarantee: Submission of this application does not guarantee acceptance into the program or immediate matching with a mentee. Mandatory Training: If accepted, you will be required to complete mandatory program onboarding and training before being matched. Commitment: You agree to uphold the stated time commitment of 2–4 hours per week (or the amount you indicated in your survey) for the duration of the mentorship period. Final Consent and Organizational Notices By checking the box below, you consent to receive communications from Asians in Recovery (AIR) and acknowledge that you have read and agree to AIR’s Terms of Use and Privacy Policy.

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Asians in Recovery Mentor Application