Mentor Interest Form

Thank you for your interest in being a peer mentor with CF Peer Connect. We appreciate that you would like to share your experiences, provide an empathetic ear, and offer encouragement to others in the CF community.

Peer mentors are onboarded every couple of months, so you will hear from the CF Peer Connect team prior to our next orientation.

Please note that personalized peer support matches are made based on the requests we receive. While you will be added to the mentor pool, there may be a considerable wait time before you are matched with someone.

If you have any questions, please contact the CF Peer Connect team at peerconnect@cff.org.

What is your connection to cystic fibrosis?*

How are you related to your family member with CF? ("I am a...")*

Name*

First Name

Last Name

Email*

What is your age range?*

What is your child's age range?*

What language(s) do you speak?*

English Spanish

Other:

I receive care at the following CF Care Center*

How old were you/your family member when you/they were diagnosed with CF?*

How old were you/your family member when you/they had a lung transplant?*

Are you or your loved one currently taking a CFTR modulator? (i.e., Kalydeco ®, Orkambi ®, Symdeko ®, and Trikafta ®)

Yes No

CF Peer Connect Comments

Please identify your areas of experience (select all that apply):

Adjusting to a new CF diagnosis Parenting at various ages and stages Supporting your child entering adulthood Finding balance as a caregiver Relationships with family members Transplant G-tube Coping with bereavement

Other:

Please identify your areas of experience (select all that apply):

Finding balance as a caregiver Coping with sickness/hospitalizations Challenges with family members Adjusting to a new CF diagnosis Transplant Coping with bereavement

Other: