Become a Mentor

Please fill this form out completely and a Raising Harts representative will be in touch within 2 weeks to set up an interview.

Full Name*

Email*

Phone*

Relationship to Child*

Town of Residence*

Occupation*

Age*

Primary Language*

Marital Status *

How old was child when they were diagnose? How old are they now?*

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Please note that the commitment to mentor is approximately 2 hours/month. This may either be in person, via text, Facetime, phone call, or Zoom.

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