Peer Alliance Program Application:

Families Fighting Autism

Peer Alliance Program Application:

Please print, fill out this form and email a picture of the filled out form to familiesfightingautism@gmail.com in order to be reviewed/paired through our buddy program!

After emailing your application, you will receive an email to set up an interview.

Please print, fill out this form and email a picture of the filled out form to familiesfightingautism@gmail.com in order to be reviewed/paired through our program!

After emailing your application, you will receive an email to set up an interview.

I am applying to be a mentor   _______

I am applying to find a mentor _______

Name:_____________________________________

Phone Number: (________)_________-__________

Email:_____________________________________

​

Adress:_________________________________________________________________________________________

________________________________________________________________________________________________

Interests:________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

​Female/ Male

Age:________

Do you have transportation/ the ability to drive?

YES/ NO

Would you be willing to drive with your mentor/mentee?

YES/NO

Why do you want to be a mentor/be paired with a mentor?

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

Tell us about yourself!

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________