Eunie's Buddies Mentorship Application
Prefill and Form Variables
Chapter Account Id
Vol Chapter Account Id
Program (PMM) Id
Vol Program (PMM) Id
Member FormAssembly ID (generated)
Child FormAssembly ID (generated)
Owner Id
Member Type
Please select...
Mentee
Mentor
Community Parent Volunteer
Interested
Please select your language.
Eunie's Buddies Mentor Registration
Eunie's Buddies Mentee Registration
To ensure our program meets your needs, we want to match you with the right mentor. Please take a moment to answer the following questions that will allow us to get to know you better.
Eunie's Buddies Community Volunteer Registration
Eunie's Buddies Interest Form
Thank you for your interest in Eunie’s Buddies,
kindly provide the following information that will allow us to reach out to you in the future
.
Where will you be participating?
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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North Carolina
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Ohio
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Pennsylvania
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Guam
Puerto Rico
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
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (DRC)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia (Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis and Futuna
Yemen
Zambia
Zimbabwe
Street Address
Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Province
Please select...
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
State/Province
State/Province for Salesforce
ZIP Code/Postal Code
Demographic Information
Date of Birth
mm/dd/yyyy
Date of Birth (normalized)
Gender Identity
Female
Male
Non-binary
Prefer not to say
Self-describe:
Marital Status
Married
Single
Divorced/Separated
Other:
Preferred Language
English
Spanish
Creole
Portuguese
Russian
Other:
Are you of Hispanic, Latino, or Spanish origin?
Yes
No
Prefer not to say
Race (select all that apply)
American Indian or Alaska Native
Asian
Black or African American
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Prefer not to say
Education level (optional)
High School
Some College
Associate's degree
Bachelor's degree
Master's degree
Doctorate degree
Occupation
Your Family
How many family members are in your household?
1
2
3
4
5
6 or more
Child's Information
Your Relationship to Child
Please select...
Biological parent
Adoptive parent
Foster parent
Stepparent
Grandparent
Legal guardian
Other
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)
Child's Gender
Female
Male
Non-binary
Prefer not to say
Other, please specify:
Has the child been diagnosed with an IDD?
Yes
No
Child's Primary Diagnosis
Please select...
Asperger Syndrome
Autism Spectrum Disorder
Cerebral Palsy
Down Syndrome
Expressive Speech Disorder
Epilepsy
Fetal Alcohol Syndrome
Fragile X Syndrome
Hearing Loss
Learning Loss
Pervasive Spectrum Disorder
Prader-Willi Syndrome
Williams Syndrome
Other, please specify:
When did you receive the diagnosis?
During pregnancy
After 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!
What are your interests? Select all that apply.
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:
How do you prefer to keep in touch with your friends?
WhatsApp
Text
Email
Talking on the phone
Social media
Video chat (FaceTime, Zoom, etc.)
Hanging out together
Tell us about yourself:
How do you envision your role as a mentor?
Your Availability
Your time is valuable. Please select the days and times that are best for you to talk to or meet with your mentee.
Your time is valuable. Please select the days and times that are best for you to talk to or meet with your mentor.
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
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 pregnancy
After birth
I currently need financial assistance to help alleviate some of the costs associated with the diagnosis.
Yes
No. I will apply when the need arises.
You will receive an e-mail with instructions on how to apply for financial aid.
How do you prefer to be contacted by your mentor initially?
WhatsApp
Text
Email
Call
Social Media
Video chat (FaceTime, Zoom, etc.)
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?
Additional Information
Tell us about your strengths. Select all that apply.
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:
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-Person
eMentorship
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
Please select...
Mobile
Home
Work
Other
Relationship to Applicant
Please select...
Parent/guardian
Spouse/partner
Other family
Service coordinator/support staff
Friend
Other
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?
Yes
No
Have you ever been convicted of a criminal offense?
Yes
No
Have you ever been charged with neglect, abuse, or assault?
Yes
No
Other than the above, is there any fact involving you or your background that would call into question your participation in Best Buddies?
Yes
No
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.
Join Eunie's Buddies
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