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Glial Program Sign Up
The Glial Program is a personalized function of Synapse that pairs a Virginia Tech student with someone who has experienced brain injury. We foster friendships between these two communities. Students and individuals who have experienced brain injury meet with each other on a regular, pair-defined basis and attend group events together. It is our intention for individuals with brain injury to spend time with someone who will become a supporter and close friend. The Glial Program sets out to encourage as we grow in perspective and experiences together.
We want to thank you for your interest in the Glial Program! Please fill out our quick questionnaire to help us pair you with an available student so the fun can begin.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
I am a...
*
Community member that has experienced brain injury
Student that has experienced brain injury
Faculty member that has experienced brain injury
Other:
Required
What's the best way we can contact you in the future?
*
If email, please make sure your email is spelled correctly above. If phone, please leave your phone number.
Your answer
What is your address?
Your answer
What transportation is available to you?
*
Car - I drive myself
Car - I have a close relative/friend to drive me
Car/taxi services
Bus
I don't have access to transportation
Other:
Required
Ideally, how often would you like to meet with your student buddy?
*
Weekly
Every Other Week
Every Once in a While
Only at Group Social Events
Other:
Required
How would you like to interact with your student buddy, in addition to in-person?
*
Select as many (or as little) as you like.
Phone Call
Letter/PenPal
Text/SMS
Email
Actually, In-Person Only
Other:
Required
What are you looking for in a student buddy?
*
e.g. Someone to go to events around Blacksburg with, to talk to, walk with, get meals with, etc.
Your answer
What are some of your interests and hobbies?
*
Your answer
Is there anything related to your health that you want us to know?
*
e.g. Is there anything that may make certain activities or events more (or less) difficult for you?
Your answer
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