Support Parent Match Request

(Please complete all SIX sections of this application)   

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PART ONE
 

Your name:     

I am looking for emotional support.

I am looking for help with my child's IEP.

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

Your relationship to the child or adult with a disability:
  
 

Sorry, our Support Parent programs are for parents and family members only.
If you need assistance, please call us at 888-612-9273.

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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 - except for the
volunteer support parent with whom you are matched.

Email Address:                   

Mailing Address: 

City:    State:    Zip: 

County:           Telephone:   

Best time to reach you by phone: 

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PART FOUR

Information about your child (for matching purposes):
 

Your child's name (optional):   

Male    Female

 Year of birth:       Current age:

 Your child's primary disability / diagnosis:

 

Age when your child's disability was diagnosed:  
 

Please include any additional information about your child that might assist in
making a good match, for example: twins; information about play/social skills,
current school placement and/or accommodations, etc.




Please include any special issues regarding your child that may
help to identify an appropriate match:

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PART FIVE

Information about you:

The main reason I would like to be matched with a volunteer Support Parent is:

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PART SIX

Terms / Signature:

I understand by submitting this match request that:

-          CFPC staff will share all my contact information with the volunteer Support Parent with whom I am matched.

-    The volunteer with whom I am matched will share their contact information with me at a level they feel comfortable with.  Support may take place by email, by phone, or in person -- according to the Support Parent's preferences.

-    If I am matched with an IEP Support Parent, that does not automatically mean that the person will be attending my child's IEP meeting.

-     Once I submit this request, I will hear from someone regarding my match within three business days.  (Most requests will be addressed within one day; delays may result as we determine and contact the most appropriate match.)

-    I can, for any reason, request a change of Support Parent.  (It's important that you feel comfortable with the person you are matched with.  Just call - and no questions asked - we will assign a different volunteer.)

By entering your full name below,
you are affixing your signature to this online request.

To help us to prevent spam, please enter a number
between 20 and 40 in the box below (and then click Submit):