Become a Peer Supporter

Thank you for your willingness to become a Parent to Parent of PA Peer Supporter! Please complete and submit the information below. Once your form is submitted, a Regional Coordinator will contact you by phone to personally explain our program. This call helps to ensure that you understand our program and your responsibilities as a Peer Supporter. Please be aware that you will not be listed as a Peer Supporter until a Parent to Parent of PA Regional Coordinator has spoken to you directly.

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Demographics
Contact Details
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By submitting this form you are agreeing to allow your information to be released to the Parent to Parent of PA program for further contact.