Peer Mentor Program Interest Form
Thank you for your interest in supporting others like you as a volunteer!

Michigan Medicine and the Office of Patient Experience are partnering to create a volunteer program for COVID-19 patients and the people caring for them. As a participant, you will be linked to a peer — someone who has experienced similar challenges and situations — to provide you with additional support and guidance along your journey.

The Peer Mentor Program will offer:
- Help connecting COVID-19 patients and caregivers to resources
- Support for COVID-19 patients and caregivers across journey
- An outlet for socialization and friendship
- A chance to learn from others who understand the challenges you face

***Please note, completing this form does not guarantee your participation or selection as a volunteer. The answers from this form will solely be used to gauge interest in the program. A Volunteer Coordinator may contact you in the future about your interest.***
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First Name *
Last Name *
Email *
Phone Number
Are you willing to travel to Ann Arbor, MI, to complete a component of training if necessary? *
Why are you interested? (Select all that apply)
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