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* 1. Name

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* 2. My pronouns are

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* 3. Email Address

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* 4. Phone Number

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* 5. Mailing Address

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* 6. Please include your availability (days and times).

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* 7. Why are you interested in mentorship?

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* 8. Do you have any clinical experience, either in a professionally or in a volunteer capacity?

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* 9. Why are you interested in supporting Twist Out Cancer's mission and work through Brushes with Cancer?

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* 10. Do you have a personal connection to cancer that you are willing to share?

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* 11. What would you identify as your strengths as a mentor?

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* 12. Do you have any preferences for mentees?

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* 13. Do you have any past experiences working as a mentor? Please share your insights.

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* 14. Do you have any concerns or barriers about becoming a mentor?

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* 15. Please indicate your understanding of commitment to the program:
You will not be assigned to specific pairs, but will be available on-call throughout the program in case a pair indicates a need for additional support. 

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