Apply to Become a Parent Mentor – Online Application

Please use this form to submit an application for becoming a TACA Parent Mentor only. You MUST answer all questions. Please put N/A if the question is not applicable.

Questions?

Contact the TACA Parent Mentor Program Coordinator.

Overview

TACA is looking to help more families affected by autism via our volunteer mentor program. We are expanding this program throughout the United States. Mentors are a crucial part of TACA’s success providing newly diagnosed families the much-needed introduction to autism and the community around their family. To make sure we adequately understand your knowledge to help newly diagnosed families – please take a few minutes to fill out this application. It will greatly help us assign mentors to the best match. THANK YOU!

TACA Mentor Reference Information

Please read the links about our free service to families in need:

Thank you for taking the time to review, fill out and consider being a TACA mentor. WE TRULY VALUE YOUR DESIRE TO HELP. We will be contacting you within a month to follow up on your application and upcoming mentor training.

Online Application to Become a TACA Parent Mentor Your First Name Your Last Name Street Address City County State Zip Code Home Phone Number (123-123-1234) Cell Phone Number (123-123-1234) Personal Email Address Listserves Email Address School District Do you have a child(ren) with Autism Spectrum Disorder (ASD)? Yes
No If "Yes" to child(ren) with ASD, what year were they born? If "No", then put "N/A". What year(s) was your child diagnosed? Does your child(ren) with ASD live with you? Yes
No Is your child(ren) with ASD recovered? Sometimes parents ask to be matched with parents of similar children based on sex or functioning level. Please list the sex (male or female) and your child's current functioning level (Aspergers, HFA-verbal, mild, moderate, LFA-nonverbal). Was your child adopted? Yes
No Is your ASD child a multiple (twins, triplets, etc)? Yes
No Are all of the multiples affected? Yes
No Are you a single parent? Yes
No Are you a Stay at Home Mom? Yes
No How many other children (non-ASD) live with your and do they have any diagnoses? Who is your DAN! (ARI) doctor? How long have you been on the biomedical journey? Who has been your favorite autism professional(s) (DAN or other)? What are the top 3 things that have worked for your child(ren)? Do you participate in any other autism support groups? If "Yes", name which ones. Have you attended any biomedical conferences or listened to their webcasts? Please list where and when. Other conferences you've attended? Are you conversational in another language besides English? Yes
No If "Yes" to the previous question, which language(s) and would you be willing to mentor in that language(s)? How long have you been a member of TACA? On a scale of 1-10, "10" being the best, please rate your knowledge in the following areas: Dietary Intervention GFCFSF SCD Other, please specify which dietary intervention(s). ("specific diet": [1-10]) DAN! Biomedical Protocols Prescribed Medications Psychotropic Medications Homeopathy/Natural Medicine Do you have any personal experience with things like sleep disorders, feeding therapy, severe GI issues (such as Eosinophilic Esophagitis), aggressive behaviors, “green” living, anaphylaxis allergies, Biofilm, PANDAS, IVIG or any cultural/religious diets? If so, please rate each 1-10. Other Medications, please specify which one(s). ("specific medication name": [1-10]) Seizures Payment Resources Medicaid/Waiver Health Insurance Military IEP/Educational Issues Homeschooling/in-home programs Do you have any personal experience with things like apraxia, hyperlexia, using private schools, social skills, legal advocacy, inclusion, Due Process or assistive technology devices (including iPad)? Please rate any 1-10. Local Resources Traditional Therapies Please list your top 3 of the above categories from "1" being the strongest.

Do you have any personal experience with things like puberty/teens, adult issues, dual diagnoses like Down Syndrome or CP, SSI or treating autism on a budget? If yes, please rate each 1-10. Please tell us a little about yourself, your autism journey and your philosophy for helping families. Do you have a website/blog?

Apply to Become a Parent Mentor – Online Application

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