PPMNY Mentor Intake Questionnaire
Thank you for your interest in serving as a volunteer Plant-Powered Lifestyle Mentor with Plant Powered Metro New York! Please answer the following questions so we can match you with a mentee who is a good fit for you! Please note that, while we do not expect our mentors to follow a whole food, plant-based (WFPB) diet to the letter at all times, we do believe that it is critical for our mentors to have personal experience following a WFPB diet (a diet emphasizing whole, plant foods including fruits, vegetables, beans and legumes, whole grains, nuts and seeds, with no added oil and low in sodium and refined sugars) in order to be knowledgeable enough to help someone else transition. Please determine for yourself if you feel that you can fully represent this way of eating as a mentor to others.
This is also not a health coaching program. Our intention is to focus on very personal aspects of lifestyle that allow people to make dietary changes. Section 2 of this form includes a waiver to this effect that must be completed before getting started with a mentee.
At this time, due to the ongoing situation with Covid-19, PPMNY’s mentorship program will be conducted virtually, with no in-person interaction between mentors and mentees. However, there is no better time than now to initiate healthy, sustainable lifestyle change (the best match for Covid-19 is a healthy immune system!), and the support and encouragement that makes a mentor so valuable is just as powerful virtually. Mentoring pairs are strongly encouraged to attend PPMNY’s virtual events together, to further become part of a community with shared values around nutrition and health.
What motivated you to begin eating a whole-food, plant-based diet? Why have you stuck with it?
What were your personal barriers to adopting a whole-food, plant-based diet (check all that apply!)
I did not know how to cook whole-food, plant-based meals.
My family and/or roommates were skeptical of a whole-food, plant-based diet.
I did not think I had the time or ability to cook this way.
I liked to eat out, and I didn't know how to eat out on a whole-food, plant-base diet.
How long have you been eating a whole-food, plant-based diet?
How long did it take you to make your dietary transition?
I made the transition to whole-food, plant-based eating all at once.
I made the transition to whole-food, plant-based eating over a few weeks.
I made the transition to whole-food, plant-based eating over a few months.
I made the transition to whole-food, plant-based eating over a year or more.
Do you have any personal experience with disease reversal through whole-food, plant-based eating? If so, and if you are comfortable sharing, please do so here.
Which of these options best describes the way you eat now?
Whole-food, plant-based, and free of added oil, salt, and sugar
Whole-food, plant-based, oil-free, and light on added salt and sweeteners
Whole-food, plant-based generally, but will occasionally eat oil, salt, and added sweeteners
Vegan, but not whole-food oriented.
I occasionally eat animal products and refined plant foods but am otherwise whole-food, plant-based.
How comfortable are you in the kitchen?
I love to cook and do it often.
I love to cook, but I don't have a lot of time.
I'm not a great cook, but I know how to put together easy whole-food, plant-based meals.
I don't cook at all. Someone else in my home prepares meals, or I use a meal preparation service.
Do you prefer a specific type of cuisine? If so, please describe it here.
Do you have experience with any of the following?
Preparing whole-food, plant-based meals for one.
Feeding family members and/or roommates who are skeptical of a whole-food, plant-based diet.
Feeding children on a whole-food, plant-based diet.
Feeding older adults you care for on a whole-food, plant-based diet.
What is your zip code?
Where in the NY Metro area do you live?
Nassau County, Long Island
Suffolk County, Long Island
Northern New Jersey
How would you prefer to communicate with your mentee? (Check all that apply!)
Phone (voice call)
Video Call (FaceTime, Skype, Zoom)
Text (Phone, WhatsApp, Facebook Messenger)
What times of the week would you prefer to communicate with your mentee?
Any time of day - my schedule is flexible!
Outside normal work hours - weeknights and weekends.
Only on weekends - I do not want to be contacted on weekdays.
Only on weeknights - I do not want to be contacted on weekends.
I am proficient in the following languages, and would be able to mentor someone in that language: (Please check all that apply!)
Which of the following best describes your race?
Asian or Pacific Islander
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native American or Alaskan Native
White or Caucasian
Multiracial or Biracial
A race/ethnicity that is not listed here
Prefer not to answer
PPMNY requests a 30-day commitment for the Lifestyle Mentorship program (though mentees and mentors have the option to extend the mentorship up to 3 months if they mutually agree). In the coming months, do you have any commitments that may disrupt your ability to participate in the mentorship program? If not, how many mentees do you have the time and energy for?
Do you have any certifications or training relevant to Lifestyle Mentorship? (e.g., eCornell Plant-Based Nutrition certificate, dietetics training, social work or behavior change training, etc.). If so, please list them!
Are you interested in serving as a Lifestyle Mentor for upcoming immersive jumpstart programs? These require more intensive support over the course of the program, ranging from 10 days to one month, and participation in events associated with the jumpstart.
Yes, I would like to help with jumpstart programs, as long as my schedule permits!
No, I prefer to mentor only in the basic 1-3 month format.
Is there anything else you would like us to know?
Never submit passwords through Google Forms.
This form was created inside of Plant Powered Metro New York.