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Questions for Pre-Trained Mentors

Upon submitting your information, you will see a confirmation message which means we have received your information. A mentor or member of OCRA's staff will be in touch with you soon. Please contact womantowoman@ocrahope.org with any questions.

First Name*

Last Name*

Email*

Phone*

Street Address 1*

City*

State*

Zip Code*

Country

Preferred method of communication*

Which Woman to Woman site do you currently volunteer with?*

About You

As we want to pair our mentors with women with similar life experiences to the greatest extent possible, please answer the following questions:

Date of Birth

Marital Status

Sexual Orientation

Do you have children?

Age(s) of children

Language(s) spoken

Religion

Race/Ethnicity

Tell us about your "real" life*

Your Story

Type of cancer*

Date of diagnosis*

Cancer stage at diagnosis*

Age at diagnosis*

Hospital/Medical center where you were treated*

Please tell us about your cancer journey so far. Include information about your disease, treatment, side effects, where you were in your life when diagnosed and where you are now.*

Volunteering

How would you like to provide support?*

On what days and during what hours are you generally available to talk with someone? *

Are there specific issues you are comfortable talking about or not comfortable talking about? If so, please explain. *

Are you comfortable discussing issues with which you personally have no experience? *

Is there anything else we should know that will help us make a good match? *

By submitting this survey you agree to keep confidential all personal information obtained while participating in Woman to Woman*