Exit Mentor Application 092217 1. Interested in a Mentor position at MPACT? Question Title * Select the Mentor position that best fits your interest. MPACT Mentors are trained volunteers who, on request, provide support to parents and family members of children with disabilities throughout the special education decision-making process. Mentors may also assist in other volunteer assignments or activities. The assignments or activities may include the following. Assignments: Providing one-to-one parent or family assistance, resources, and/or referrals by phone, email, or in person Preparing and supporting parents and family members to be effective participants in their child’s individualized educational plan (IEP) meetings or other educational meetings Disseminating resource materials and specific disability information at resource fairs or community events Providing “What is MPACT” presentations to parent support groups, organizations, and universities Activities: Participate in quarterly Mentor meetings online or in person Participate in quarterly Mentor trainings online or in person Submit required reporting documentation Provide input for MPACT’s strategic plans MPACT Transition Mentors are trained volunteers who specialize in the transition process from school to adult life. In addition to completing the core Mentor trainings and performing the same activities and duties as Mentors, Transition Mentors complete additional activities and duties which may include the following. Providing one-to-one parent, family, and/or youth assistance, resources, and/or referrals by phone, email, or in person specific to the transition to adult life process Linking parents, families, and/or youth to adult service organizations and community resources Providing facilitation or support for the MPACT Region Transition Networks (RTN) within the Mentor’s geographical region Question Title * The following questions must be answered by those interested in becoming a Transition Mentor: What experiences do you have in working with parents, families, and youth through the transition process to adult life? What resources do you use specific to the transition from high school to the adult life process? Question Title * Please fill in your contact information in the space below. Items with an * must be completed to proceed to next section. *Name: * Your Position: Address: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Zip Code: *Email Address: * *Phone Number: * Question Title * Do have internet and computer access? Yes No Question Title * Do you have a driver’s license? Yes No Question Title * Do you have car insurance? Yes No Question Title * Current Employer Employer Name Position City Question Title * Please explain any professional skills, special interests, hobbies, or personal experiences you believe MPACT could benefit from you sharing. How would you describe your relationship with your child’s school district? What special education related resources do you use most often? What are your strengths in IEP or special education services negotiations? In which areas do you feel you need more support or training? Question Title * Experience: What is the highest level of education you have completed? Describe all past volunteering experiences, including names of the organization/agency. Do you belong to any groups or clubs? Please describe. Please list any trainings related to disabilities or special education law you have attended. Have you attended educational meetings to provide support to other parents or families? If so, how many? Question Title * Referral: How did you hear about the MPACT Mentor volunteer program? What interested you in applying for this MPACT Mentor volunteer position? What do hope to gain from this volunteer experience? 17% of survey complete. Next