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Mentor Intake Form

Please fill out this short form to be considered for the WeStutter@Work (WS@W) Mentorship Program. We appreciate your interest in helping the stuttering community. 


Please read and review the expectations for mentors: Expectations

Please note: this program is only available for people: 

- Based in North America and 

- Over the age of 22


Disclaimer: The National Stuttering Association (NSA) Mentorship Program is a voluntary peer-support program facilitated by NSA volunteers. Participation is at each individual’s discretion. The views and advice shared by mentors and mentees are personal and do not necessarily reflect those of the NSA. This program is not a substitute for professional therapy, counseling, or career services. The NSA does not evaluate participants, guarantee outcomes, or monitor individual interactions. The NSA is not responsible for any actions, decisions, or consequences arising from participation in the program. Participants are expected to engage respectfully and maintain confidentiality within the bounds of the program.

Are you a person who stutters or an ally?
Person who stutters
Ally
Do you reside in North America?
Yes
No
How old are you?
18-25
25-30
30-40
40-50
50+
What phase are you at in your career?
Recent college graduate
Early career
Mid level role
Senior level role/Manager
Executive
Retired
Out of work, but job searching
What are your primary areas of expertise or subjects you feel comfortable mentoring in?
What is your preferred mentoring style?
Directive (providing specific advice and guidance)
Non-directive (asking questions to help the mentee find their own solutions)
Collaborative (a mix of both, working together with the mentee)
How many mentees are you willing to take on at a time?
1
2
3
More than 3

(Approx time commitment per mentee is ~1 hour/month)


What is your preferred frequency for mentoring sessions?
What is your time zone?
Eastern
Central
Mountain
Pacific
Other
Which days are you available?
Monday availability
Tuesday availability
Wednesday availability
Thursday availability
Friday availability
Saturday availability
Sunday availability
Do you have any prior mentoring experience?
Yes
No

Disclaimer: The National Stuttering Association (NSA) Mentorship Program is a voluntary peer-support program facilitated by NSA volunteers. Participation is at each individual’s discretion. The views and advice shared by mentors and mentees are personal and do not necessarily reflect those of the NSA. This program is not a substitute for professional therapy, counseling, or career services. The NSA does not evaluate participants, guarantee outcomes, or monitor individual interactions. The NSA is not responsible for any actions, decisions, or consequences arising from participation in the program. Participants are expected to engage respectfully and maintain confidentiality within the bounds of the program.

Have you read and understood the rules, expectations and disclaimer of the program?
Yes
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