Helping Parent Mentor Volunteer Application

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A Helping Parent Mentor is a parent who has a child/loved one with a disability or special health care need and is trained by Parent to Parent to provide personal support for families who have a child/loved one with similar needs. Mentors help the families they are matched with cope with challenging experiences and feelings by offering support, encouragement, and showing other families that they are not alone in their journey. If you are interested in becoming a Helping Parent, please fill out the form below. We collect demographic information to help us match families, all information is kept strictly confidential.

After you submit this form, we will contact you to talk about when we can offer training and give you more details about the program. Thank you for your interest in becoming a Helping Parent Mentor!

Christie Chiles - Grays Harbor Parent to Parent Coordinator
Amber Cook - Pacific County Parent to Parent Coordinator

Questions? 360-537-7000 or info@arcgh.org

Email *

Parent First Name *

Parent Last Name *

Parent Birth Date *

YYYY

Phone Number *

What is the best way to contact you? (Check all that apply) *

Phone

Text message

By mail

Other:

Required

Address Line 1 *

Address Line 2 (optional)

City *

State *

Zip *

Parent's Race (Select all that apply) *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Other:

Required

Parent's Ethnicity *

Not Hispanic/Latino

Hispanic/Latino

Prefer not to answer

County you Reside in *

Grays Harbor County

Pacific County

Other:

Child's Name *

Child's Birthdate *

YYYY

Child's Race (Select all that apply) *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Other:

Required

Child's Ethnicity *

Not Hispanic/Latino

Hispanic/Latino

Prefer not to answer

School District you live in *

School (if any) your child attends *

Please select from the following in regards to your child: *

Developmental Delay/Disability

Health Issues or Concern

Other:

Required

Diagnosis of Child *

Why do you want to become a Helping Parent Mentor? *

Tell us about any relevant previous (personal or professional) experience you have that would be helpful as a Helping Parent.

Please check ALL that apply, I'd like to: *

Receive Info on Parent Support Groups

Be added to the Parent to Parent Email Newsletter List

Be added to The Arc of Grays Harbor Email Newsletter List

Learn about other resources

Other:

Required

How did you hear about us?

The Arc of Grays Harbor Newsletter

Parent to Parent Newsletter

Our Website

Social Media

School District

Physician or Therapist

Other:

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