Trusted Parents

Next Class: November 7, 2020

To register, fill out the form below!!!

Become a Mentor Parent Form

If you would like to become a Mentor Parent, please complete and submit the form below. Once we receive your completed Mentor Parent Form you will be contacted by our office via email, with further details about the training.

Mentor Parent Family Information Form:

If you are a parent or primary caregiver of an individual with special needs, reside in the state of North Carolina, and would like to provide emotional support and information to other families facing challenges similar to what you have experienced, please fill in the form below. Submit only the information you are comfortable with providing. (Contact information is required). All information is kept confidential.

We will protect all information provided, including names, addresses, phone numbers, birthdates, and medical information. For details see our Privacy Statement.

Mentor Parents Information

In which county of North Carolina do you live:
Full Name
Email Address
Address:
Phone Number:
Best time of day to call:
Is it ok to call you at work?:
- Yes
- No
Work Phone:
Best time to reach you at work?:
Ethnic Group
Domestic Status:
Languages:
Diagnosis of your child With Special Health Care Needs or Disability
Your Child's Name
Your Child's DOB:
Sex:
List al disabilities or conditions
Please include any additional information about your child that might assist in making a good match (i.e., twins, disability that resulted from an accident, play/social skills, hobbies/interests, ect.) If you would like to speak to another parent about a specific topic related to your child, please indicated.
Please include any special issues or concerns you may have regarding your child.
Trusted Parents has my permission to release my name and phone to another parent for support:
Submit Form

Thank you for registering to become a support parent! You will receive an confirmation email from our coordinator within 24 hours.
Thank you,
Family Support Network of Trusted Parents

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