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 Mindy.deibler@vtfn.org

Question Title

1. Your Contact Information (Required.)

Question Title

2. What language do you feel most comfortable speaking?

Question Title

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

Question Title

4. (Optional) What is your race?

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

9. Information About Your Child with a Disability or Special Health Care Need (Required.)

Question Title

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

Question Title

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

Question Title

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

Question Title

13. (Optional) Other Children in the Household

Question Title

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

Question Title

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

Question Title

16. Why do you want to become a Support Parent? (Required.)

Question Title

17. Please select all experiences that apply to you/your child. (Required.)

T