Apoyo de padre a padre

El apoyo de padre a padre siempre ha sido el corazón de Raising Special Kids. Cada año, más de 300 familias en Arizona están conectadas con padres «mentores» veteranos que han recorrido un camino similar y que comprenden los desafíos de criar a un niño con una discapacidad o necesidad especial de atención médica.

Raising Special Kids Family Referral Form

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Please select one of the following:

Professional Information

Your First Name

Your Last Name

I am a:

Agency

Phone

Family Information

Parent/Caregiver's First Name

Parent/Caregiver's Last Name

Chosen Pronouns

Other Pronouns

Primary Language

Preferred Method of Contact

Phone

City

County

Child's First Name

Child's Last Name

Date of Birth

Chosen Pronouns

Other Pronouns

Child's Diagnoses:

Needs Information About

Additional Information

Optional Information

This information helps us ensure that we are serving our entire community. This section is optional and has no impact on the availability of services from Raising Special Kids. Our services are always available at no cost to all Arizona families.

Race

Ethnicity

Do You Receive Public Assistance

Examples include free school lunches, Income-based AHCCCS, SNAP.

# of Household Members

Household Income

Contact Information

Raising Special Kids Family Referral Form

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