Mito 411 Volunteer Response Form
There are some error(s). Please see each marked section below.
Required Question(s)
1.
I choose the following months in 2008 to be a volunteer for Mito 411 (choose at least one, up to three).
February
February
March
March
April
April
May
May
June
June
July
July
August
August
September
September
October
October
November
November
December
December
Comment:
150 character(s) left.
2.
Select the following areas where you have experience and could share your experience or perspective with a Mito 411 caller. (No medical advice please!)
New diagnosis/stress of going through a diagnosis
New diagnosis/stress of going through a diagnosis
Childhood Mito issues
Childhood Mito issues
Adult Mito issues
Adult Mito issues
School-age Mito issues/advocacy
School-age Mito issues/advocacy
Support for spouses of adult patients
Support for spouses of adult patients
Support for parents of a very disabled/medically fragile child
Support for parents of a very disabled/medically fragile child
Support for parents of a Mito child who "looks normal"
Support for parents of a Mito child who "looks normal"
Managing multiple doctors, the medical system, or complex information
Managing multiple doctors, the medical system, or complex information
Maximizing quality of life
Maximizing quality of life
End of life issues
End of life issues
Other
Comment:
150 character(s) left.
3.
Please briefly describe yourself so that others will know a little about you for Mito 411.
350 character(s) left.
4.
I have already completed the Mito 411 Volunteer Training and am ready to be a volunteer for my chosen month!
Yes
Yes
No, I still need to complete the telephone training but want to be a volunteer
No, I still need to complete the telephone training but want to be a volunteer
Comment:
150 character(s) left.
5.
Contact information (for MitoAction use only). Include name, email address, and best telephone number to reach you, as well as time zone.
350 character(s) left.