Mentor Program Request

Mentor Program Request

The Mentor Program provides one-on-one support to families and individuals living with type 1 diabetes (T1D). Trained volunteers that have experienced understand the daily challenges of living with T1D are there to provide emotional support, and connect you with resources in your local area.

Please complete the form below to be matched with a mentor in your local area.

*First Name:

*Last Name:

*Street Address:



*Postal Code:

*Phone Number:


*Date of Birth (mm/dd/yyyy):

*Date of Diagnosis (mm/dd/yyyy):

 I consent to receive electronic messages from JDRF Canada, including emails, text messages, social network messages, contest notifications, publications, e-newsletters, updates, announcements, events, promotions and invitations. This information will not be shared and you will always have the option to unsubscribe.

* Required Fields

You can view our Privacy Policy to see how we use the information we collect.

Lets turn type one into type none