Mentor Enrollment
Volunteers interested in serving a mentoring role with OCD Texas should submit the following information. Mentoring opportunities may be available at varying formats, frequencies, and inquiry types. Your responses will be used to support your interests, match your experience with the needs of mentor-seekers, and enhance the potential for a fulfilling experience for all.
Email address *
First Name *
Your answer
Last Name *
Your answer
Primary phone (xxx-xxx-xxxx) *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip *
Your answer
Emergency Contact Full Name *
Your answer
Emergency Contact Phone number *
Your answer
Birth date *
MM
/
DD
/
YYYY
Are you over 18? *
Employment Information
If under 18, parent/guardian full name and phone number:
Your answer
Please list any medical conditions:
Your answer
How often are you interested in participating in mentorship activities?
What format of communication do you prefer for providing your experience and general information about OCD treatment?
What level of therapy experience do you have?
Please indicate any concerns with the following: *
Required
Endorsing any of the above concerns does not qualify an applicant from mentorship, but we would like to know more. Please describe:
Your answer
What sparked your interest in becoming a peer mentor with OCD Texas? *
Your answer
Please indicate areas of experience you are willing to share with a mentee. *
(Check all that apply.)
Required
Select treatment components or terms with which you are familiar: *
Required
Please note any questions for the team.
Your answer
A recommendation from a provider or support figure is required. How will this recommendation be submitted? *
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