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IEP Support Parent Certification Training Application

(Please complete all SIX sections of this application)   

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PART ONE
 

Your name:         

We provide this training program in three regions.

Which regional training are you applying for?

East Central - TBA Late Summer 2010
 

  North / East - TBA Autumn 2010

The deadline for applications for the West Central event - May 21-23, 2010 - is past.

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PART TWO
 

Your role (please check one of the following):

I am a PARENT (or caregiver) of a child or an adult with a disability.

  I am a PARENT (or caregiver) of a child or an adult with a disability AND I am also a professional in a field related to disability and/or special education.

Your professional title:  
 

Organization / Agency: 

  I am another family member of a child or an adult with a disability.

Your relationship to the child or adult with a disability:
  

Sorry, only parents, caregivers, or other family members are eligible for this program.

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PART THREE

Your contact information for our Matching Database:

Central Florida Parent Center will not publish nor divulge your personal

information to anyone outside of our organization.  Parents who wish to be matched

with a veteran parent will give us their contact information, which we will forward
to the volunteer IEP Support Parent to whom they are matched.

Email Address:                       

Mailing Address: 

City:    State:    Zip: 

County:           Telephone:   

Best time to reach you by phone: 

 Age of your child with a disability:  

 Your child's primary diagnosis: 

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PART FOUR

Information About You & Your Experience

Tell a little about your own experience with your own child’s IEP process.

Briefly explain why you believe that you will be helpful to parents as
they prepare for the IEP meeting.

If you speak any other languages besides English, list them here: 

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PART FIVE

Why?

I am interested in becoming an IEP Support Parent because:

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PART SIX

Terms / Signature:

As a Certified IEP Support Parent with Central Florida Parent Center (CFPC),
you would be asked to provide support and information to parents who expressed a
need for help with their child's educational planning.  This assistance may include
attendance, with the parents, at their child's IEP meeting. 

I understand, as an IEP Support Parent Certification Applicant, that:

-          I will be expected to adhere to CFPC Volunteer policies and procedures, including those which protect confidentiality.

-     IEP Support Parents are not advocates and do not "speak for" the parents whom they are there to support.

-          the slots for this training event are extremely limited and the submission of this application does not necessarily guarantee each applicant a seat.

-     this program includes a three-day training and that completion of the training does not automatically mean referrals will be made to every participant.

-          I might not be matched right away – referrals are made based upon the needs of parents and other factors like location.

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you are affixing your signature to this online application.

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