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NAME
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First
Last
PHONE
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EMAIL
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ADDRESS
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City
State
Zip Code
Country
AGE
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OCCUPATION
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DO YOU HAVE CHILDREN? IF YES, HOW MANY AND WHAT AGE(S)?
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LANGUAGES SPOKEN
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WHAT OPPORTUNITIES ARE OF INTEREST TO YOU? (CHECK ALL THAT APPLY)
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Mentoring
Driving
Cleaning
WHICH AREAS ARE YOU WILLING TO SERVE? (CHECK ALL THAT APPLY)
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Abbotsford
Aldergrove
Chilliwack
Mission
Langley
Surrey
Prince George
WHEN ARE YOU AVAILABLE TO START?
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WHICH DAYS OF THE WEEK ARE YOU AVAILABLE? CHECK ALL THAT APPLY.
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
WHAT TIME OF DAY ARE YOU AVAILABLE? CHECK ALL THAT APPLY.
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Morning
Afternoon
Evening
DO YOU HAVE ANY ALLERGIES? IF YES, PLEASE LIST.
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ARE YOU COMFORTABLE WITH ANIMALS?
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Yes
No
PLEASE TELL US WHY YOU ARE INTERESTED IN BECOMING A MENTOR.
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PLEASE LIST YOUR STRENGTHS, PASSIONS, AND PERSONAL EXPERIENCE THAT YOU FEEL WOULD LEND WELL TO OUR PROGRAM.
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AS A PART OF OUR MATCHING PROCESS WE TRY TO MATCH MENTORS WITH MOMS THAT HAVE SHARED EXPERIENCE. PLEASE CHECK OFF ANY OF THE FOLLOWING BOXES THAT YOU HAVE EXPERIENCED OR CAN RELATE TO. (PLEASE NOTE THAT THIS INFORMATION IS KEPT STRICTLY CONFIDENTIAL)
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BREASTFEEDING SUCCESS
BREASTFEEDING CHALLENGES
CESAREAN BIRTH
ABUSIVE RELATIONSHIP
ADOPTION
MINISTRY (SOCIAL SERVICES) INVOLVEMENT
ADDICTION
SINGLE PARENTING
SEXUAL ABUSE SURVIVOR
BIRTH TRAUMA
OTHER
DESCRIBE IF/HOW FAITH, RELIGION, OR SPIRITUALITY IMPACT YOUR PERSONAL DAY TO DAY LIFE.
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PLEASE PROVIDE US WITH THE NAME AND PHONE NUMBER/EMAIL OF A PERSONAL CHARACTER REFERENCE. THIS CAN INCLUDE A LONG TIME FRIEND, MENTOR, COACH, PROFESSOR, PASTOR/PRIEST.
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PLEASE FEEL FREE TO SHARE ANY OTHER INFORMATION THAT YOU FEEL WOULD BE RELEVANT.
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HOW DID YOU HEAR ABOUT BEYOND THE BUMP?
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ABOUT
APPLY FOR CARE
MENTEE FEEDBACK FORM
VOLUNTEER
MENTOR PORTAL
DONATE
TESTIMONIALS
RESOURCES