I AM ALS Peer Support Specialist Application Question Title * 1. Thank you for your interest in volunteering as an I AM ALS Peer Support Specialist! Before we get started, please introduce yourself. First Name Last Name Birth Date (MM/DD/YYYY) Email Phone Question Title * 2. What is your preferred method of communication? Phone Email Question Title * 3. What is your connection to ALS? Please select all that apply. I have been diagnosed with ALS I may have ALS I am the primary caregiver for a loved one diagnosed with ALS I am a loved one of someone diagnosed with ALS I lost someone diagnosed with ALS I am an ALS gene carrier I am an ALS healthcare professional I do not have a connection to ALS My connection is not listed (please specify) Other (please specify) Question Title * 4. What is your relationship to the person diagnosed with ALS? Self I am their spouse or domestic partner I am their parent I am their sibling I am their adult child I am their friend I am their paid caregiver Other (please specify) Next
