Parent Matching Form
The Parent to Parent Mentoring Program is intended to be a short-term program for parents to connect with other parents who are caring for their child/children with a mental health condition or multiple conditions. Once a match has been made, the Parent Mentor and Parent Mentee will meet up to 4 times, starting from the initial match meeting, over a phone call or virtual meeting platform.

If you would like to be matched with a trained Parent Mentor, please fill out the following form.

Any data you provide in this survey will be kept confidential unless disclosure is required by law. In any report we publish, we will not include information that will make it possible to identify you or any individual mentioned in this survey.

For any questions, please contact Richelle Mah at richelle@namisf.org.
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Email *
First name: *
Phone number and best time to call: *
Best way to contact you: *
County of residence: *
This information is helpful for matching you with someone residing in the same/nearby county, so that the mentor can potentially share regionally appropriate resources with you.
Age and gender of child: *
Does your child have a diagnosis/diagnoses? If yes, please include the diagnosis/diagnoses or a short description of the issues. *
At what age was your child diagnosed or how long have they been experiencing mental health issues/emotional challenges? *
What’s happening now? Any specific issues your child/family are facing? *
Has your child or is your child currently receiving any mental health support?  If so, what types? *
Are there any specific resources or information you are looking for? *
What are you hoping most to gain from the Parent Mentor Program and/or the mentor/mentee relationship? *
How did you hear about the Parent Mentor Program? *
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