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
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Your answer
Last Name
*
Your answer
Email
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Your answer
Phone Number
Your answer
Are you willing to travel to Ann Arbor, MI, to complete a component of training if necessary?
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Yes
No
Why are you interested? (Select all that apply)
I have experienced COVID-19
I was caring for someone with COVID-19
Other:
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