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.
Name *
Your answer
Email Address *
Your answer
What motivated you to begin eating a whole-food, plant-based diet? Why have you stuck with it? *
Your answer
What were your personal barriers to adopting a whole-food, plant-based diet (check all that apply!) *
Required
How long have you been eating a whole-food, plant-based diet? *
Your answer
How long did it take you to make your dietary transition? *
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. *
Your answer
Which of these options best describes the way you eat now? *
How comfortable are you in the kitchen? *
Do you prefer a specific type of cuisine? If so, please describe it here.
Your answer
Do you have experience with any of the following? *
Required
What is your zip code? *
Your answer
Which parts of the NY Metro area are easy-access for you/where do you visit frequently? *
Required
How would you prefer to communicate with your mentee? (Check all that apply!) *
Required
What times of the week would you prefer to communicate with your mentee? *
I am proficient in the following languages, and would be able to mentor someone in that language: (Please check all that apply!) *
Required
PPMNY requests a 3-month commitment for mentorship. 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? *
Your answer
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!
Your answer
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 live events associated with the jumpstart. *
Is there anything else you would like us to know?
Your answer
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