Parent Leadership Program 2020 Application

Application deadline is April 20, 2020

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* 1. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 2. Home Phone Number

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* 3. Mobile Phone Number

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* 4. The area where I live is:

Urban

Suburban

Rural

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* 5. Are there any special accommodations necessary for you to participate?

Yes

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* 6. If yes, please specify (e.g., accessibility, interpreter, transportation, etc.)

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* 7. Please confirm your commitment to the Parent Leadership Program by initialing each of the expectations on the space provided by checking the box next to it.

I commit to 20 hours of sessions.

1 commit to 2 in person sessions, dates to be determined.

I understand that excused absences must be approved by the Parent Leader Program Coordinator.

I will maintain confidentiality for families to whom I provide advocacy assistance.

I agree to be in contact with Parent Network of WNY on a quarterly basis.

Please fill out the following questionnaire. The information provided will help Parent Network of WNY select participants.

Parent Leadership Program 2020 Application

Question Title

* 1. Contact Information

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* 2. Home Phone Number

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* 3. Mobile Phone Number

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* 4. The area where I live is:

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* 5. Are there any special accommodations necessary for you to participate?

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* 6. If yes, please specify (e.g., accessibility, interpreter, transportation, etc.)

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* 7. Please confirm your commitment to the Parent Leadership Program by initialing each of the expectations on the space provided by checking the box next to it.

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* 8. Why are you interested in the Parent Leadership Program?

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* 9. What skills/knowledge do you bring to the program?

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* 10. What skills/knowledge do you hope to gain from the program?

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* 11. Have you participated in any groups (parent groups, committees, etc)?