Web Intakes - P2P of PA

Agency Peer Supporter Intake

If you are referring a parent who has agreed to Become a Peer Supporter for the Parent to Parent of PA program, please complete the Peer Supporter intake form and choose your Agency name from the "Referred By" drop down field below.

Demographics

Prefix

First Name

Middle Name

Last Name

Referred By

Referring Employee Details

Name

Phone

Contact Details

Primary Phone

x Ext.

Other Phone

x Ext.

P2P E-mail List

YesNo

Preferred contact method

How can we help?

Line 1

Line 2

City, State

Zip

County

P2P Mailing List

YesNo

Interested in learning more about...

Be Strong Families: Parent Cafes

P2P of PA hosts Parent Cafes for Pennsylvania families who have young children (ages 0 to 5) receiving Early Intervention or Home Visiting/Family Supports Services. Parent Cafes use structured, small group conversations to facilitate transformation and healing within families, build community, develop peer-to-peer relationships, and engage families as partners in the programs that serve them. Parent Cafes are a chance to meet and talk with other families about the joys and challenges of parenting.

C2P2 EI: Competence and Confidence, Partners in Policymaking Early Intervention

C2P2EI is a leadership training program for families with children who receive Early Intervention services. C2P2EI provides up-to-date information on best practices, resources, and policy issues. C2P2EI participants learn about the Infant/Toddler and Preschool Early Intervention System, have opportunities to connect with other families and build their skills to advocate for their family and others.

P3D: Parents as Partners in Professional Development

P3D brings together families of children who have received Early Intervention services with opportunities to contribute to professional development. In certain instances, OCDEL is able to reimburse families for expenses and provide consulting fees for their time and experience.

By submitting this form on the behalf of the parent/caregiver you agree that they have given you verbal permission to release his/her information to the Parent to Parent of PA program for further contact.