PARENT MENTOR APPLICATION

First Name

Last Name

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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What is the month & year of your last NICU experience?

This is your childs last day in the NICU

What gestational age was your baby born?

How many days was your child in the NICU?

Please tell us about your NICU experience including any area which may be helpful for us when we match you with other parents?

(Micro preemie, IVF, bedrest parent, full term NICU parent, 2nd/3rd time NICU parent, multiples parent, adoption of a NICU baby, breastfeeding challenges, being discharged on oxygen, trach experience ect.) Any and ALL details are welcomed here, and please share with us what you would be comfortable sharing with a new parent.

Is there anything else you'd like us to know?

How much time can you commit to being a parent Mentor?

This can fluctuate... Just give us your best guess at this point... 20 minutes/week? 20 minutes/day? 20 minutes a month? All helpful to know.

Tell us why you'd like to be a parent mentor, and why you think you'd be a good support for a new NICU parent.

CONTACT US

CONTACT@PROJECTNICU.COM