1. Parent to Parent Volunteer Application

 

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

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

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

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

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* 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?

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* 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?

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* 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
Flexible
Strict
Energetic
Physically Affectionate
Emotionally Expressive
Able to Admit Mistakes
Accepting
Frustrated
Supportive
Detail Oriented
Able to Make Decisions
Outgoing
Organized
Objective
Passive
Trusting
Optimistic
Easy Going
Impulsive
Open to New Ideas
Accepting of Change
Protective
Self Confident
Lenient
Consistent
Logical
Contented

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

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

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

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

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

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

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* 14. Please feel free to make any further comments:

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