Bari Angels Mentor Application
Apply to become a Bari Angels Mentor and support others on their bariatric journey.
Personal Information
Tell us about yourself.
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City & State
*
Bariatric Background
Share your bariatric surgery experience.
Have you had bariatric surgery?
*
Yes
No
What surgery did you have?
*
Please Select
Gastric Sleeve
Gastric Bypass
DS / SADI
Lap Band (current or removed)
Revision (please specify)
Other (please specify)
Surgery Date
*
-
Month
-
Day
Year
Date
Starting Weight (lbs or kg)
*
Current Weight (optional)
Total Weight Lost (lbs or kg)
*
Surgeon / Hospital / Clinic (optional)
Wellness & Journey Reflection
Reflect on your bariatric journey.
Please share a brief summary of your bariatric journey (challenges, victories, mindset changes, or anything that shaped you).
*
What have been your biggest successes since surgery?
*
What were your biggest challenges, and how did you overcome them?
*
Mentorship Readiness
Share your motivation and areas of mentoring confidence.
Why do you want to become a mentor with Bari Angels?
*
Which areas do you feel confident mentoring in? (Select all that apply)
*
Pre-op guidance
Post-op expectations
Nutrition basics
Emotional support
Accountability & consistency
Mindset & motivation
Exercise / movement
Dealing with plateaus
Regain support
Life after major weight loss
Other (please specify)
Mentor Preferences
Tell us about your ideal mentoring match and style.
What type of mentee do you feel most equipped to support? (Pre-op, early post-op, long-term, dealing with regain, struggling with mindset, etc.)
*
Preferred communication style
*
Text
Phone call
Video chat
Email
No preference
Preferred mentor style
*
Direct & structured
Gentle & supportive
Balanced
Depends on the mentee
How many mentees can you mentor at once?
*
1
2–3
4+
Availability
Let us know your time commitment and best check-in times.
How much time can you commit weekly to mentoring?
*
1–2 hours
3–5 hours
5+ hours
Best days/times for check-ins
*
Program Expectations & Agreement
Please read and acknowledge the following expectations.
Please acknowledge the following:
*
I understand I am providing peer support, not medical advice.
I agree to maintain confidentiality and professionalism.
I understand this is a volunteer role with no compensation.
I agree to communicate consistently with my mentee(s).
I will notify Bari Angels if I need to pause or discontinue mentoring.
Signature (typed name)
*
Date
*
-
Month
-
Day
Year
Date
Submit Application
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