Peer to Peer Support Volunteer

  • Peer to Peer Support Volunteer Form

    This form will help us match you with an Oley community member is requesting support on their journey. Your responses are confidential and stored securely. We do not share this information with anyone outside of the matching process. Please skip any questions you do not feel comfortable answering.
  • Format: (000) 000-0000.
  • Date of Birth
     - -
  • Age Range (Note: If you are under 18, please have your parent complete this form. We do not knowingly collect or store personal information from minors under 18 without parental consent.)*
  • Preferred Pronouns
  • I am a:*
  • How long have you or your loved one been using nutrition support?*

  • Click "Next' to finish survey

  • Are there specific topics you would like to talk about with a peer? ? (Check all that apply)*
  • How would you prefer to be contacted by your peer match?*
  • Do you prefer a peer who shares your same:*

  • Oley peer-to-peer agreements

  • Agreement  
    By joining, you agree to: 

    • Use peer support for encouragement, not treatment. 
    • Maintain confidentiality and respect others' boundaries. 
    • Avoid giving medical advice or pressuring others to share. 
    • Keep the space safe, inclusive, and supportive for everyone involved. 

  • Acknowledgment and Signature 
    I have read and understood the Oley Peer-to-Peer Support Agreement. By submitting this form, I agree to uphold the responsibilities outlined above and participate in a respectful and supportive manner. 

  • We'll do our best to match you with someone who shares your experience and can offer support, insight, or just a friendly chat. Expect to hear back within 48-72 hours.

  • Thank you for completing the survey 

  • Should be Empty: