Pair Program Patient Application

Thank you for your interest in the No Worries Now Pair Program! Completed applications and recommendations are due Friday, April 19th, by midnight, and can be submitted using the form below. If you prefer, you may e-mail answers to the below questions to krishan@noworriesnow.org instead of using the online form.

All applicants will be interviewed over the phone on April 26th-28th. You will be assigned an interview time for the date and notified in advance. If you are not available to be interviewed on the assigned date, please notify us well in advance and we will try our best to accommodate you.

Because this is a Pilot Program, we will only be able to accommodate up to 10 pairs. We will select patients on a first-come-first-served basis, dependent on whether we are able to find the patient a good volunteer match. Applicants will be notified of their acceptance to the program by April 1st.

Important: All applicants must be available for the Welcome Event, where pairs meet for the first time, on Saturday, June 15th.

Questions about the application process can be directed to Krishan Patel, LA Pair Program Director, at krishan@noworriesnow.org

Personal Info

Name*

Email*

Gender*

School*

Grade*

Date of Birth*

Cell Number*

Home Phone

Address*

City

State

Zip Code

Academic Interests*

Hobbies*


Favorite...

Movies

Books

Bands/Songs

Foods:

Sports Teams:

Cities/Places

Your Perfect Day


More About You

Why are you interested in being a part of the No Worries Now Pair Program? What do you hope to gain from your participation?*

Please describe your personality, interests, hobbies, background and anything else that might help us pair you with a volunteer.*

What qualities and interests would your ideal volunteer have? What would you like to do together? What gender and age range are you comfortable with?*

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