Thank you for taking the time to
fill out the FCE application. Please review the qualifactions below
and then complete the application. In addtion, please print, sign and
mail the Informed Consent.
• Have a chronic medical condition that significantly
impacts your life on a daily basis;
• Can commit to mentor for at least two years;
• Have a willingness to share stories about your illness and life;
• Require regular physician visits for treatment of illness;
• Live within 30 miles of Ann Arbor
Before submitting this application, please review
it for accuracy. If you have any questions, please contact firstname.lastname@example.org or
by phone at (866) 337-0017.