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Parent Information Form

The purpose of the parent directory/database is to empower families to support one another through networking.

By completing the Parent Information Form you agree to become part of the F.I.N.D. database/directory and are willing to be available to network with other parents. You will also have access to other families through a F.I.N.D. representative, the F.I.N.D. Family Forum, and links to disability related activities (calendar, trainings, etc.). Your personal information will be kept confidential and will not appear on our website. If you have any questions, please call 1-515-243-1713 or 1-800-450-8667.


Parent/Guardian Information

Parent/Guardian Name
 
Address
 
City
 
Zip Code
 
County
 
Telephone
 
Email
 

Child/Youth Information

Child/Youth Name (please fill one form per child)
 
Year of Birth
If child is deceased please indicate year
 
School District
 
Classroom Setting
General Ed
Resource Room
Self Contained
 
Graduation Year
Age at graduation?
 
Diagnosis
(check all that apply)









 Other:
 
 
Post High School
 
 
Education
 
 
Employment


 
 
Living Arrangement


 
 
Community Activities
 
Special Info
Would you like to help organize the following in your area?

Other:
 

Parent/Guardian Knowledge

Willing to share knowledge with others (check all that apply)














Other:
 
Additional Comments
 

If you would like a copy for your files please print before submitting.

ASK Family Resource Center
321 East Sixth Street Des Moines, IA 50309
Phone: 515-243-1713/1 800-450-8667  Fax: 515-243-1902
Email info@askresource.org Website www.askresource.org

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