Eunie's Buddies Mentorship Application

Where will you be participating?

State for lookup

Please select your mentorship preference.

Where do you want to volunteer?

Your Contact Information

First Name

Last Name

Nickname / Preferred Name (optional)

E-mail Address

Mobile Phone

Country

Street Address

Address Line 2

City

State

Province

State/Province

State/Province for Salesforce

ZIP Code/Postal Code

Demographic Information

Date of Birth

mm/dd/yyyy

Date of Birth (normalized)

Marital Status

MarriedSingleDivorced/SeparatedOther:

Are you of Hispanic, Latino, or Spanish origin?

YesNoPrefer not to say

Occupation

Your Family

Child's Information

Your Relationship to Child

Child's First Name

Child's Last Name

Child's Date of Birth/Due Date

mm/dd/yyyy

Child's Date of Birth

mm/dd/yyyy

Child's DOB (normalized)

Has the child been diagnosed with an IDD?

YesNo

Child's Primary Diagnosis

When did you receive the diagnosis?

During pregnancyAfter birth

Fun Facts about You

To facilitate a meaningful connection, we prioritize matching you with a mentee who shares similar interests. Please feel free to select all options that resonate with you!

To facilitate a meaningful connection, we prioritize matching you with a mentor who shares similar interests. Please feel free to select all options that resonate with you!

Tell us about yourself:

How do you envision your role as a mentor?

Additional Information

Your needs are important to us. Could you please share where you are in your process? Select all that apply to your current circumstance and emotional state:

I just received the diagnosis.I received the diagnosis some time ago, but I am still struggling.I need a friend that has been through what I am going through.I would like to speak to someone that can answer questions that I have from a parent perspective, someone that is already on this journey.I am OK with the diagnosis but do not know where to start.I would like guidance on resources such as early stimulation programs, specialists, social services, schools, local organizations, etc.I haven’t received a specific diagnosis, but after several medical opinions I am certain there is an intellectual or developmental disability.Other:

When did you receive the diagnosis?

During pregnancyAfter birth

I currently need financial assistance to help alleviate some of the costs associated with the diagnosis.

YesNo. I will apply when the need arises.

You will receive an e-mail with instructions on how to apply for financial aid.

Is there anything else you would like to share or any other additional information you believe is important for us to consider when selecting a mentor for you?

How did you hear about Eunie's Buddies?

Please specify nonprofit/healthcare professional:

Partner: chose other?

If you chose other, please specify:

Name of person who told you about us:

Referral Source for Salesforce

Additional Information

Why is this opportunity important to you?

What would you like to learn more about (check all that apply)?

I want to know when Eunie's Buddies launches in my area.I want to help launch Eunie's Buddies in my area.I'm not ready to be paired in a mentorship now, but I might be in the future.I want to learn about something else (please specify).

How would you like to be involved in Eunie's Buddies?

Mentee: sign up to be paired with a mentor parent or caregiver who has walked a similar path.Mentor: allocate time to provide insight, encouragement, and support to parents or caregivers who are new to the IDD community.

Preferred Type of Mentorship (check all that apply):

In-PersoneMentorship

Please provide any additional details that will help us understand how to help you:

Interest Details

Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Phone Type

Relationship to Applicant

Emergency Contact E-mail Address (optional)

Background

For the safety of all Eunie's Buddies participants, we kindly ask that you answer a few additional background questions as part of your application.

Have you been fired or asked to resign from a paid or volunteer position because of any kind of harassment or physical violence?

YesNo

Have you ever been convicted of a criminal offense?

YesNo

Have you ever been charged with neglect, abuse, or assault?

YesNo

Other than the above, is there any fact involving you or your background that would call into question your participation in Best Buddies?

YesNo

If you answered yes to any of the background questions above, please provide details below:

Consent for Background Check

A background check is required to become a Eunie's Buddies mentor. Once your application is received, a Best Buddies staff member will follow up with additional details and next steps.

I understand and consent to a background check.

Membership Agreement

I agree to the Best Buddies Member Agreement and hereby apply for membership with Eunie's Buddies.

Best Buddies may use photo/video of me and/or my child for publicity purposes.

Animals and pets	Arts and crafts	Books and reading
Comedy (e.g. standup, improv)	Dance	Fitness (e.g. running yoga, working out)
Food (e.g. eating out, baking, cooking)	Games (e.g. board games, card games, tabletop games)	Movies and TV
Music (e.g. concerts, playing an instrument)	Outdoors (e.g. hiking, biking, rock climbing)	Religion, faith, and spirituality
Shopping	Sports	Theater (e.g. acting, drama, musicals)
Travel	Video Games	Volunteering and activism
Other:

WhatsApp	Text	Email
Talking on the phone	Social media	Video chat (FaceTime, Zoom, etc.)
Hanging out together

Monday morning	Monday afternoon	Monday evening
Tuesday morning	Tuesday afternoon	Tuesday evening
Wednesday morning	Wednesday afternoon	Wednesday evening
Thursday morning	Thursday afternoon	Thursday evening
Friday morning	Friday afternoon	Friday evening
Saturday morning	Saturday afternoon	Saturday evening
Sunday morning	Sunday afternoon	Sunday evening

WhatsApp	Text	Email
Call	Social Media	Video chat (FaceTime, Zoom, etc.)

Administrative	Advocacy	Computer - data entry
Education/Teaching	Event management	Fundraising
Graphic design	Matchmaking	Organizational skills
Photography	PR/Media Relations	Public speaking
Social media management	Social skills	Sales
Writing and editing	Other: