ECHO - Transition Mentorship Survey - Participant RSVP

With funding from the Texas Council on Developmental Disabilities, Baylor College of Medicine’s Transition Medicine Clinic has developed a Transition to Adult Care Peer Mentorship Program for individuals with Intellectual and Developmental Disabilities (IDD). This 6-month program can be held in-person or by virtual meeting with 5 mentors and 10 mentees per session. Training includes mentor and mentee orientations, five monthly mentor-lead group sessions about various transition topics, and goal setting with mentor/mentee follow-up.

As a participant in the ECHO training, you will learn how to facilitate this program and will receive coaching if you choose to host your own peer mentor program. All materials for the program will be provided.

Please provide the following Participant Information.

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* 1) Name

First Name

Last Name

Preferred Email Address

Preferred Telephone Number

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* 2) Professional Title

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* 3) Affiliated Organization

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* 4) What is your interest in hosting the peer mentorship program in your organization? (Check all that apply.)

a) I would like to learn more.

b) I hope to host a mentorship group this year.

Other (please specify)

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* 5) As part of each ECHO session, participants will present a case to facilitate discussion about each session topic. The case can address selecting appropriate mentors/mentees, a mentoring relationship situation, etc. If you present a case, please do not share the person’s name or other personal identifying information.

Would you like to present a case?

Yes