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VMS - Family Link Parent Mentor (reg)
*
Question - Required -
Are you currently the main caregiver of a child/teen with diabetes?
Please select response
Yes
No
Question - Not Required -
How long has it been since you have been the main caregiver for a child/teen with diabetes?
Less than 5 years
5 years or more
Question - Not Required -
Have you lived with/cared for a child/teen with diabetes for a total of 1 year or more?
Please select response
Yes
No
Question - Not Required -
Currently, how old is your child?
Please select response
Under 1 year
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18 or older
Question - Not Required -
How old was your child when s/he was diagnosed with diabetes?
Please select response
Under 1 year
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18 or older
Question - Not Required -
What gender is your child?
Male
Female
Question - Not Required -
Can you devote a minimum of 4 hours per month to work with families and file reports on your interactions?
Please select response
Yes
No
Question - Not Required -
Would your child's health care provider provide a letter of recommendation stating that you would be an appropriate mentor for parents of newly diagnosed children/teens?
Please select response
Yes
No
Question - Not Required -
Would you be willing to submit to a national background check for criminal and sexual offenses?
Please select response
Yes
No
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