Peer Support Volunteer Application

Thank you for your interest in becoming a CLF Peer Support Volunteer. Please tell us a bit about yourself and follow the instructions on the next page to book a phone call with our Peer Support team. If you have any questions or concerns, please email support@concussionfoundation.org.

First Name

Last Name

Phone

Country

City

State/Province

Zip Code

Address Lines

Age

Date of Birth (MM/DD/YYYY)

Gender Identity

Preferred Pronouns

Race

Race (Non-USA)

Have you personally experienced a concussion or persistent-post concussion symptoms (PPCS)?

Are you a caregiver for someone struggling with the effects of brain trauma, now or previously?

Patient's relationship to you

Patient's Age

Patient's Issue

Are you currently experiencing symptoms you believe may be due to suspected Chronic Traumatic Encephalopathy (CTE)?

Why do you want to get involved with the CLF Peer Support Connection Program?

Contact Information