Peer Support Application for New Loss Families
OVERVIEW
Hope for HIE is the premiere global non-profit patient advocacy organization, dedicated to improving the quality of life for children and families impacted by neonatal and pediatric-acquired Hypoxic Ischemic Encephalopathy through awareness, education and support.

This Peer Support Mentor program matches up families new to HIE loss with experienced, compassionate, trauma-trained peer parent leaders who provide emotional peer support to families through a 1:1 Peer Mentor experience.

Through this program, the aim is to decrease the impact of trauma, connect families to resources and build meaningful connections within the Hope for HIE network of families. Paired mentorships are geared towards a one year structured relationship, and can be terminated by either party at any time.

Mentors and mentees will be paired through a process developed by Hope for HIE's social worker. Participants will decide upon a mutually agreed upon frequency and method of contact within the identified scope of the program.

We hope you will find this program valuable in your journey. For any questions or concerns, you may reach out to Haley Thomas, LMSW, at any time, Haley@hopeforhie.org
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Email *
First Name *
Last Name *
Phone Number *
Mailing Address 1: *
Mailing Address 2:
City *
State/Province/Region *
Zip/Postal Code *
Country *
How do you prefer your mentor contact you? *
Emergency Contact Name: *
Emergency Contact Phone: *
Relationship to Emergency Contact: *
Relationship Status: *
Do you have other children? *
Languages Spoken: *
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