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Participant Intake Form

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


Please read and review the expectations for participants: Expectations

Please note: this program is only available for people: 

- Based in North America and 

- Over the age of 18


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?
Yes
No
Do you reside in North America?
Yes
No

Note: This program is only open to people residing in the North America region.


How old are you?
18-25
25-30
30-40
40+
What phase are you at in your career?
Student
Recent college graduate
Early career
Mid level role
Senior level role/manager
Executive
Retired
Out of work, but job searching
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