Please complete the following application to apply for the Family Leadership Development Program. Once submitted, a member of the program staff will reach out to discuss your application further. Please remember that space is limited so not all applicants will be accepted into this cohort. If you do not meet the eligibility requirements or are not selected for the program, you will be notified by email.

Eligibility
You must be a parent or caregiver to a school-aged child with mental health challenges.
You must be a Howard County resident.
You must be willing to commit to attending both days of the event.


Program Dates:
Friday, May 10, 2024 - 5:00 pm - 9:00 pm
Saturday, May 11, 2024 - 8:00 am - 4:30 pm

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* 1. Your First Name

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* 2. Your Last Name

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* 3. Email Address

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* 4. Telephone Number

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* 5. Are you a resident of Howard County?

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* 6. Home Address (Applicants must be Howard County residents)

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* 7. Race

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* 8. Ethnicity

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* 9. What are your preferred pronouns?

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* 10. Are you the parent or caregiver to a school-aged child with mental health challenges?

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* 11. What is your role in relation to the child?

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* 12. How old is your child with mental health challenges?

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* 13. Has your child been diagnosed by a physician with a specific mental health challenge? Note: A specific diagnosis is not required to participate in the program.

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* 14. Is yes, what mental health diagnosis has your child been given?

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* 15. If no, what behaviors does your child exhibit that lead you to believe they might have a mental health challenge?

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* 16. Is your child enrolled in school?

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* 17. If your child attends a Howard County Public School, what is the name of the school?

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* 18. What grade is your child in?

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* 19. Is your child receiving special education services from Howard County Public Schools? (IEP, 504 Plan, speech language, occupational therapy, etc).

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* 20. Does your child have an IEP (Individualized Education Plan)?

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* 21. Does your child have a 504 Plan?

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* 22. What are your child's challenging behaviors either at home or at school?

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* 23. What concerns do you have about the supports and services your child is receiving at school?

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* 24. What mental health services is your child receiving in the community, outside of school?

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* 25. Are there additional services you think would be helpful for your child?

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* 26. As the parent or caregiver, what challenges are you experiencing supporting your child?

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* 27. What are your goals for attending the Family Leadership Development Program? What knowledge or skills do you hope to gain? What questions to you hope to have answered?

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* 28. This is a 2-day program that has the most benefit when parents and caregivers attend all the workshops held on both days. Do you foresee any challenges attending for the entire 2 day program?

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* 29. MCF covers the cost of the your hotel room for the evening of Friday, May 11th. Would you like to stay in a room at the hotel?

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* 30. MCF can provide limited funds (up to $40) to help pay for childcare so that you can attend the event. Will you need this financial assistance?

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* 31. MCF can provided limited funds (up to $25) to help cover transportation expenses to make it easier for you to attend the event. Will you need this financial assistance?

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* 32. What else would you like us to know about you, your child, or your family?

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