Bari Angels Mentee Application
Apply to be matched with a mentor who understands your bariatric journey. Complete this application to help us pair you with the best mentor for your needs.
Personal Information
Please provide your contact details so we can reach you.
Full Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
City & State
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Bariatric Journey
Tell us more about your bariatric journey so far.
Where are you in your bariatric journey?
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Considering surgery
Pre-op
Newly post-op (0–3 months)
Post-op (3–12 months)
Long-term post-op (1+ year)
Have you selected a surgery type?
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Yes
No
Not sure yet
If yes, what type?
Gastric Sleeve
Gastric Bypass
DS / SADI
Lap Band
Revision (please specify)
Other (please specify)
Surgery date or expected date (if applicable)
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Month
-
Day
Year
Date
Surgeon / Clinic (optional)
Goals & Support Needs
Help us understand your goals and where you need support.
What are your main goals for joining this mentorship program? (Emotional support, accountability, lifestyle changes, weight-loss education, etc.)
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What areas do you need the most support with? (Check all that apply)
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Pre-op guidance
Nutrition basics
Post-op recovery
Emotional support
Building healthy habits
Mindset + motivation
Exercise / movement
Managing plateaus
Preventing regain
Long-term lifestyle changes
Other (please specify)
Mentor Preferences
Tell us about your preferences for a mentor match.
Would you prefer a mentor who had the same surgery type?
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Yes
No preference
Preferred mentor style
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Direct / structured
Soft / encouraging
Balanced
Not sure
Preferred communication style
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Text
Phone calls
Video chat
Email
No preference
Is there anything specific you want us to know when matching you with a mentor? (Triggers, boundaries, scheduling needs, personality preferences, etc.)
About You
Share more about your journey, challenges, or hopes.
Tell us a little about your journey, challenges, or hopes going into this mentorship. (Anything that helps us understand where you are emotionally, mentally, or physically.)
*
Program Agreement
Please read and acknowledge the following to participate in the program.
Signature (typed name)
*
Date
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Month
-
Day
Year
Date
Submit Application
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