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:_________________________________________________________________________________________


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Interests:________________________________________________________________________________________


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​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?


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Tell us about yourself!


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