Application deadline Friday, April 6, 2018
For more information contact Theresa Drum at 716/332-4170 or tld@parentnetworkwny.org

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* 1. Name

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* 2. Address

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* 3. Work Phone

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* 4. Cell Phone

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* 5. Email Address

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* 6. The area where I live is (please choose one)

Urban

Suburban

Rural

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

Yes

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

Please confirm your commitment to the Parent Leadership Program by checking each of the expectations on the space provided.

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* 9. I agree to attend all full day Saturday training sessions

April 28th, 9 am to 3 pm

June 2nd, 9 am to 3 pm

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* 10. I agree to the following:

I agree to complete the additional required independent learning opportunities for a total of 8 hours

To complete 2 additional optional Parent Network trainings

I will participate in the evaluation process by completing the evaluation forms and giving feedback

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 on a quarterly basis

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

Application deadline Friday, April 6, 2018
For more information contact Theresa Drum at 716/332-4170 or tld@parentnetworkwny.org

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* 1. Name

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* 2. Address

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* 3. Work Phone

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* 4. Cell Phone

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* 5. Email Address

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* 6. The area where I live is (please choose one)

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

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

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* 9. I agree to attend all full day Saturday training sessions

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* 10. I agree to the following:

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

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

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

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* 14. What skills/knowledge do you hope to gain from this program?

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