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Parent Match Program: Volunteer Application

Thank you so much for your interest in becoming a Support Parent in our Parent Match program. All the information you provide on this form will be kept confidential and will help us find the best possible match for families who are seeking support. Our Parent Match Program is one of several ways Vermont Family Network supports families. You can read more about the Support Parent role and responsibilities here. After we review your application, we will invite you to a complete a webinar to learn more about how to be an effective Support Parent. If you have any questions, please contact marie.fetterhoff@vtfn.org.

Your Contact Information
* First name
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* Last name
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* Address:
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* City:
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* State:
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* Zip Code:
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Email address:
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Best contact phone number:
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1. What language do you feel most comfortable speaking?
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2. What other languages do you speak fluently?
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3. (Optional) What is your race?
4. (Optional) Are you of Latino or Hispanic decent?
5. (Optional) Do you consider yourself to be a New American immigrant?
6. How did you hear about Vermont Family Network's Parent Matching Program?
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7. What is your relationship to child with a special health care need or disability (please select all that apply):
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For other, please explain:
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Information About Your Child with a Disability or Special Health Care Need
Your child's full name:
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Your child's date of birth:
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Your child's self-identified gender:
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Your child's primary diagnosis:
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Your child's secondary diagnosis:
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8. (Optional) What is the race of your child with a special health care need or disability?
9. (Optional) Is your child with a special health care need or disability of Latino or Hispanic decent?
10. What else would you like us to know about your child with a special health care need or disability?
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11. (Optional) Please share information about other children in the household: Full names, dates of birth, self-identified gender(s), dignosis (if any)
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12. What else would you like us to know about other children in the household?
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13. Is there anything unique about your family structure, culture, or interests that would help us make an appropriate match with another parent?
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* 14. Why do you want to become a support parent?
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15. Please select all experiences that apply to you/your child:
Experiences continued...
Experiences continued...
Experiences continued...
Experiences continued...
Experiences continued...
Other (please specify)
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