Parent Support Request

As a parent of a Deaf child we invite you to connect with other parents in our Families Supporting Families network . The program is designed to give parents opportunities to express feelings in a safe and confidential environment with trained parents. By filling out this form I give permission to California School for the Deaf Outreach Division to share my contact information with a parent in the Parents Supporting Parents Program. I understand that this information will be kept confidential.

1. Contact Info

First Name

Last Name

City

State

Email Address

Home Phone

Video Phone

Cell Phone

What is your deaf child's name?

What is your child's date of birth?

Does your child have any additonal (other than hearing status) needs?

2. I prefer to be contacted at my:

3. What languages do you use at home?

1
2
3

4. When are the best times to contact you?

1st choice
2nd choice

5. What services do you and your child currently receive? (i.e. Early Start home visits, DHH itenerant teacher, OT, PT, ASL tutoring, interpreting, playgroup, speech therapy) *This question is required.

6. Who are your service providers? (i.e. name of school district, hospital, etc)

7. Tell us about your family and the support you are looking for. (i.e to talk to another parent with a cochlear implant, talk to a Spanish speaking parent)

Parent Support Request

Welcome to Families Supporting Families -matching families with Deaf and Hard of Hearing children.