Parent to Parent Volunteer Application
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1. Parent to Parent Volunteer Application

1. Please list your name, address and phone number.

Please list your name, address and phone number. Name
Address
Phone Number
Best Time to Call
Parent/Guardian/Other Family Member

2. What is the primary language spoken in your household?

What is the primary language spoken in your household?

3. What is your occupation, place of employment and work phone number?

What is your occupation, place of employment and work phone number? Occupation
Place of Employment
Work Phone Number

4. Total number of children in household? Number of children with disabilities?

Total number of children in household? Number of children with disabilities? Total number of children in household
Number of children with disabilities

5. What have been the most rewarding events or the easiest years for you in your role as the parent of a child with a disability?

What have been the most rewarding events or the easiest years for you in your role as the parent of a child with a disability?

6. What have been the most painful events or the most difficult years for you in your role as the parent of a child with a disability?

What have been the most painful events or the most difficult years for you in your role as the parent of a child with a disability?

7. Please indicate those characteristics which most nearly describe your parenting style. The purpose of this checklist is to gain an idea of your parenting style. This may be useful in matching you with another parent.

Please check the appropriate boxes.

	Always	Often	Sometimes	Not Often	Rarely
Patient	*Please indicate those characteristics which most nearly describe your parenting style. The purpose of this checklist is to gain an idea of your parenting style. This may be useful in matching you with another parent. Please check the appropriate boxes. Patient Always	Patient Often	Patient Sometimes	Patient Not Often	Patient Rarely
Flexible	Flexible Always	Flexible Often	Flexible Sometimes	Flexible Not Often	Flexible Rarely
Strict	Strict Always	Strict Often	Strict Sometimes	Strict Not Often	Strict Rarely
Energetic	Energetic Always	Energetic Often	Energetic Sometimes	Energetic Not Often	Energetic Rarely
Physically Affectionate	Physically Affectionate Always	Physically Affectionate Often	Physically Affectionate Sometimes	Physically Affectionate Not Often	Physically Affectionate Rarely
Emotionally Expressive	Emotionally Expressive Always	Emotionally Expressive Often	Emotionally Expressive Sometimes	Emotionally Expressive Not Often	Emotionally Expressive Rarely
Able to Admit Mistakes	Able to Admit Mistakes Always	Able to Admit Mistakes Often	Able to Admit Mistakes Sometimes	Able to Admit Mistakes Not Often	Able to Admit Mistakes Rarely
Accepting	Accepting Always	Accepting Often	Accepting Sometimes	Accepting Not Often	Accepting Rarely
Frustrated	Frustrated Always	Frustrated Often	Frustrated Sometimes	Frustrated Not Often	Frustrated Rarely
Supportive	Supportive Always	Supportive Often	Supportive Sometimes	Supportive Not Often	Supportive Rarely
Detail Oriented	Detail Oriented Always	Detail Oriented Often	Detail Oriented Sometimes	Detail Oriented Not Often	Detail Oriented Rarely
Able to Make Decisions	Able to Make Decisions Always	Able to Make Decisions Often	Able to Make Decisions Sometimes	Able to Make Decisions Not Often	Able to Make Decisions Rarely
Outgoing	Outgoing Always	Outgoing Often	Outgoing Sometimes	Outgoing Not Often	Outgoing Rarely
Organized	Organized Always	Organized Often	Organized Sometimes	Organized Not Often	Organized Rarely
Objective	Objective Always	Objective Often	Objective Sometimes	Objective Not Often	Objective Rarely
Passive	Passive Always	Passive Often	Passive Sometimes	Passive Not Often	Passive Rarely
Trusting	Trusting Always	Trusting Often	Trusting Sometimes	Trusting Not Often	Trusting Rarely
Optimistic	Optimistic Always	Optimistic Often	Optimistic Sometimes	Optimistic Not Often	Optimistic Rarely
Easy Going	Easy Going Always	Easy Going Often	Easy Going Sometimes	Easy Going Not Often	Easy Going Rarely
Impulsive	Impulsive Always	Impulsive Often	Impulsive Sometimes	Impulsive Not Often	Impulsive Rarely
Open to New Ideas	Open to New Ideas Always	Open to New Ideas Often	Open to New Ideas Sometimes	Open to New Ideas Not Often	Open to New Ideas Rarely
Accepting of Change	Accepting of Change Always	Accepting of Change Often	Accepting of Change Sometimes	Accepting of Change Not Often	Accepting of Change Rarely
Protective	Protective Always	Protective Often	Protective Sometimes	Protective Not Often	Protective Rarely
Self Confident	Self Confident Always	Self Confident Often	Self Confident Sometimes	Self Confident Not Often	Self Confident Rarely
Lenient	Lenient Always	Lenient Often	Lenient Sometimes	Lenient Not Often	Lenient Rarely
Consistent	Consistent Always	Consistent Often	Consistent Sometimes	Consistent Not Often	Consistent Rarely
Logical	Logical Always	Logical Often	Logical Sometimes	Logical Not Often	Logical Rarely
Contented	Contented Always	Contented Often	Contented Sometimes	Contented Not Often	Contented Rarely

8. Please explain which of the above characteristics have been the most helpful to you in parenting your child.

Please explain which of the above characteristics have been the most helpful to you in parenting your child.

9. Please explain which of the above characteristics have been the least helpful to you in parenting your child.

Please explain which of the above characteristics have been the least helpful to you in parenting your child.

10. Please describe briefly how and from what source you received the most support in adjusting to your child's disability.

Please describe briefly how and from what source you received the most support in adjusting to your child's disability.

11. Would a system of Parent to Parent Support have been helpful to you? If so, why?

Would a system of Parent to Parent Support have been helpful to you? If so, why?

12. What do you expect to gain from the experience of being a Support Parent?

What do you expect to gain from the experience of being a Support Parent?

13. What is your goal as a Support Parent in a relationship with a newly identified parent?

What is your goal as a Support Parent in a relationship with a newly identified parent?

14. Please feel free to make any further comments:

Please feel free to make any further comments:

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Parent to Parent Volunteer ApplicationExit this survey

1. Parent to Parent Volunteer Application

Parent to Parent Volunteer Application
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