Parent Guide Application Form

Download and print the Parent Guide Application Form
Complete and submit the online application below

Your Name (required)





Phone number

1. What strengths do you have that would make you a good Parent Guide? Be specific.

2. What information was helpful to you in making decisions about your own child’s communication mode?

3. How did you find that information?

4. What is your bias in regard to communication options for children who are deaf and hard of hearing?

5. What challenges have you experienced in raising your child who is deaf or hard of hearing?

6. What have you found to be supportive for you?

Please list two references. One reference should be an educational professional with whom your have worked on your child’s IFSP/IEP or services for your child. Each reference must complete the Parent Guide Letter of Reference.

NAME of reference and PHONE number

1. Name

Phone number

2. Name

Phone number

You will be notified when interviews will take place, either in person on by phone.
We anticipate the interview taking 30 minute. We will do our best to accommodate your schedule.

Please select the best time for you.

Your Email (required)

Your Name

Is there anything you want to add?

By submitting this form online, you understand that completion and selection for the Guide By Your Side program requires a commitment of time, motivation and energy. Individuals selected as a Parent Guide are required to attend a training sessions and commit to participating in the program for a minimum of one year.

This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.