Thank you so much for your interest in becoming a Support Parent in our Parent Match program. All the information you provide on this form will be kept confidential and will help us find the best possible match for families who are seeking support. Our Parent Match Program  is one of several ways Vermont Family Network supports families. You can read more about the Support Parent role and responsibilities here. After we review your application, we will invite you to a complete a webinar to learn more about how to be an effective Support Parent. This is a new training that we plan to role out this fall (2020). In the meantime, if you have any questions, please contact Molly.Lawney@vtfn.org.

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* 1. Your Contact Information

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* 2. What language do you feel most comfortable speaking?

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* 3. What other language(s) do you speak fluently?

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* 4. (Optional) What is your race?

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* 5. (Optional) Are you of Latino or Hispanic decent?

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* 6. (Optional) Do you consider yourself to be a New American immigrant?

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* 7. How did you hear about Vermont Family Network's Parent Matching Program?

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* 8. Your relationship to child with a special health care need or disability (please select all that apply):

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* 9. Information About Your Child with a Disability or Special Health Care Need

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* 10. (Optional) What is the race of your child with a special health care need/disability?

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* 11. (Optional) Is your child with a special health care need/disability of Latino or Hispanic decent?

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* 12. What else would you like us to know about your child with a special health care need/disability?

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* 13. (Optional) Other Children in the Household

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* 14. What else would you like us to know about other children in the household?

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* 15. Is there anything unique about your family structure, culture, or interests that would help us make an appropriate match with another parent?

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* 16. Why do you want to become a Support Parent?

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* 17. Please select all experiences that apply to you/your child.

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