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I would like a Recovery Mentor
First name
Your answer
Email address you would like to use with your Recovery Mentor (By providing your email, you are giving us permission to communicate confidential information with you through this email.)
Your answer
Phone number you would like to use with your Recovery Mentor (they can call or text you)
Your answer
If you are comfortable providing the following information, this will help your Recovery Mentor get to know you more.
Would you like a mentor that is close to your age?
What is your age?
Your answer
Would you be comfortable specifying your gender? If so, please describe below.
Your answer
Do you have a preference for a specific gender, culture, ethnicity or otherwise for your mentor? If so, please let us know.
Your answer
What challenges with your eating disorder recovery are you currently struggling with?
Your answer
What kind of support do you want and need from a Recovery Mentor?
Your answer
Why would you like a Recovery Mentor?
Your answer
How did you hear or find out about the ANAD Mentorship Program? (This helps us out with promoting the program!)
Your answer
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