Thank you for your interest in participating in the AAKP Mentorship Project in partnership with Emory University and Kaiser Permanente Georgia! 
Please share with us your contact information.  Your address will not be shared with your mentees.  This is only for internal project purposes.

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* 1. Contact Information

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* 2. Are you interested in participating in the AAKP Peer Mentorship Program (a 6-month pilot program)?

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* 3. This mentorship project will be conducted virtually (not in-person). What is your preferred method of interacting with Mentees? (Please check all that apply.)

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* 4. How comfortable are you using a computer, laptop or tablet to conduct video chats via FaceTime, Zoom, or another platform?

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* 5. Are there any times throughout the week that you are not available to communicate with mentees?  Please list times below.  We understand this may be subject to change.

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* 6. How did you hear about this mentorship project?

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* 7. Did you, or do you currently, have a mentor who has helped, or is helping, you navigate your personal journey with kidney disease?

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