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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 *