American Transplant Foundation
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Thank you for filling out our Mentee application and for taking another step forward in your transplant journey. We hope that you are able to achieve guidance and support through this program.

This form does not require you to sign in. Please click the "Save" button at the top of the page when completed and we will be in touch!

Our Mentors are dedicated volunteers who help others in the transplant community during their personal time, so we ask that you please remain engaged with your Mentor and communicate with them as often as you'd like. If you are unsure if you need Mentorship services, please do not hesitate to contact us at 303-757-0959 or support@americantransplantfoundation.org.

Mentee Contact Information
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Demographic Information
This program is completely free to those who need it. You can support this lifesaving initiative by joining our monthly giving program Save a Life Giving Club. Any amount makes a big impact!

Note: The following information is entirely optional, and is submitted with this application at will. Should you provide this information, it will assist the Foundation in the matching process.
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Matching Preferences
How would you prefer to communicate with your mentor? Check all that apply
 
 
 
 
What are your preferred contact times- Weekday
     
What are your preferred contact times- Weekend
     
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Your Transplant Journey
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Tell Us About Yourself
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What are your goals in working with a Mentor? Check all that apply
 
 
 
 
 
 
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Research Questions
The following questions are required, but the answers will not affect your eligibility in the Mentorship Program. Your responses will never be linked to you as an individual and will only be reported in aggregate. Your answers help our foundation ensure this program s availability and may help us tailor assistance to transplant patients in the future.
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Mentee Agreement
I understand that as a Mentee participating in the American Transplant Foundation (ATF) 1+1=LIFE Peer Mentorship Program, any advice I receive in the course of the mentoring relationship is solely for the purpose of guiding and supporting me in my transplant experience. I understand this relationship is designated to be a resource to discuss general issues regarding the transplant process, as well as to provide guidance, friendship, and emotional support. I understand and agree that I will not rely upon a Mentor s advice and/or statements as medical advice and that I will not rely upon a Mentor s advice as a substitute for my own independent judgment. I further understand and agree that the Mentor does not and cannot offer any advice about specific medical or non-medical tests, physicians or other providers, products, or procedures, and that the Mentor does not and cannot otherwise give medical advice. I also agree that I will not solicit or ask a mentor for any financial assistance. I hereby acknowledge that Mentors are volunteers only, and that they are not employees or agents of ATF nor do they represent ATF in any capacity. I also acknowledge that ATF does not have direct involvement with the mentoring relationship once a match is made. Because all aspects of the mentoring relationship are solely under the Mentor and Mentees control, I waive any claims against ATF, its officers, directors, member, employees, and/or agents. I agree that in no event will I file a lawsuit or other action or otherwise attempt to hold liable ATF, its officers, directors, member, employees, and/or agents for any damages that may result from my participation in the 1+1=LIFE Peer Mentorship Program.
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If the Mentee is a minor, the undersigned Parent/Guardian agrees that he/she has read the “Mentee Disclaimer and Release” and understands and agrees to ATF s policies relating to the 1+1=LIFE Mentorship Program. The Parent/Guardian consents to the minor s participation in the 1+1=LIFE Peer Mentorship Program.

Please press the green "Save" button at the top of the screen to submit. Thank you!

By submitting this application, you consent to the American Transplant Foundation contacting you in the future, when need be.

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