Buddy Program
Please answer the following questions if you are interested in being paired with an individual with a traumatic brain injury.
Name *
Your answer
Stanford Email Address *
Your answer
Cell Phone Number *
Your answer
Class Year *
Your answer
Major (or undeclared) *
Your answer
Why do you want to participate in the buddy program? What do you hope to get out of experience? *
Your answer
Ideally, how often would you like to interact with your brain injury buddy? *
Where would you be willing to meet with your buddy should he or she express the desire to get together in person? *
Required
Would you be willing to go to a peer support group meeting at a clinic in San Jose for 1-2 hours on Wednesdays (5:30-7:30pm) twice per quarter (can coordinate carpools/reimburse for Uber/Lyft)?
What are some of your hobbies/interests? *
Your answer
Would you prefer to have a buddy that is the same gender as you? *
Have you attended a Stanford Synapse group training session? *
Deciding to participate in the buddy program is a commitment. Are you willing to maintain regular contact with your buddy? *
A three-strike system will be enforced. That is, three strikes (failure to contact your buddy by a designated deadline, failure to attend an event you RSVP'd to, failure to respond to inquiries from the buddy program coordinators, etc.) and we will have to reassess your status as a participant in the buddy program.
Is there anything else you would like us to know? Do you have any questions or concerns?
Your answer
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