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Mentor Parent
Request
Thank you for reaching out to request the support of a mentor parent.
Please fill out this form so we can connect with you and provide the best volunteer mentor parent match possible. At this time, we are able to provide mentor parent matches for families with children age 5 and under and who live in Santa Clara County. If you live elsewhere, please contact
info@php.com
and we can provide resources in your area.
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* Indicates required question
Email
*
Your email
Your name:
*
Your answer
Your ethnicity
*
White
Hispanic
African American
Asian
Asian Indian
Multiracial
I don't want to say
The language you speak in the home (we will try to match you with a Mentor Parent who speaks the same language at home):
*
Your answer
Best way to contact you:
*
Email
Phone
Your phone number, and the best time to connect with you (only if you are comfortable sharing)
*
Your answer
Age of child/children with a disability or delay:
*
0-1
1
2
3
4
5
What is the gender of your child/children
Your answer
What is the nature of the child/children's' disability or delay? If there is no specific diagnosis, that's ok - just describe how the delay or disability impacts your child.
*
Your answer
The city and zip code you live in:
*
Your answer
What are your main concerns regarding your child/family that you would like a parent partner to help you with?
*
Learning more about how the disability/delay impacts the child and family
How to deal with preschool/school
Tips on coping with family and friends' comments
I am new in this community and want to meet another family
Other:
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