To Become a Living Donor Buddy Complete the questionnaire below. Click on the “Submit” button. You will receive a confirmation of receipt of your entry by email. First Name (required) Last Name (required) Address City State/Province Zip Code Email (required) Remember to include your full email address including the domain name, for example, my_email@gmail.com. Use an email address that doesn’t change. Don’t use your work email. If your email changes, be sure to notify us so we can keep your contact information current. Your email address will not be disclosed in the Living Donor Buddy entry to protect your privacy. It will be shared only with potential donors interested in contacting you. Your Gender FemaleMaleNot disclosed Your Marital Status SingleMarriedNot disclosed Are you a donor? YesNoNot disclosed What did you donate? (required) —KidneyLiverLungBone MarrowOtherNot disclosed What was the date of donation? If you selected “Other,” please specify what you donated: To whom did you donate (for example, son, sister, parent, cousin, or unrelated)? Was the recipient an adult or child? —AdultChildDon’t know At what transplant facility or hospital did you donate? Answer this question only if you donated a kidney: What surgical procedure was used to remove your kidney? —Open nephrectomyLaparoscopic nephrectomyDon’t knowOther If “Other,” please describe the procedure: Have you received any formal training to be a counselor or mentor to living donors? —YesNo How would you rate your donation experience? (required) —Very positiveMostly positivePartially positive and partially negative, or neutralMostly negativeVery negative Describe the reasons why someone would want you as their Living Donor Buddy: (required)