Personal Information

Name:

Age:

Place of Residence:

Educational Background:

Employment Status:

Disease or Condition:

Diagnosis

What age were you when the symptoms started? What symptoms did you experience?

How much time passed before you received the diagnosis? How old were you when you were diagnosed?

Relationship with the Disease

How did you cope with the news of your diagnosis? How did your friends and family react?

What treatment or therapies are you currently using? Do you experience any kind of disability?

Have you attended any conference/seminar/workshop related to your disease in the last 3 years?

Are you actively involved in any patient association? For how long? What kind of activities do you engage in?

Personality

How would you describe yourself? What are your main hobbies and interests? What was your favorite subject in school?

What would you say are your strengths related to your personality?

What would you say are your weaknesses related to your personality?

What would you like other patients and parents to know about your disease?

Program Intentions and Expectations

What does being a mentor mean to you? How would you describe this role?

What do you think are the benefits of mentoring someone younger?

How do you think being a mentor can impact your personal and professional growth?

What skills do you think you could share and teach as a mentor?

What challenges do you think might arise from being a mentor, and how do you plan to address them?

What advice would you give to someone considering becoming a mentor?