Circle of Care, Inc. Parent to Parent - Parent Referral

Do you know of a parent needing help navigating the child welfare system? A mentor is an individual who has lived experience who can assist you with your DHS case. If you would like a mentor to guide you through the process, please complete this referral form.

 

Instructions

Please complete one referral per parent. If you have any questions, please email parenttoparent@circleofcare.org. The mailbox is check daily.

 
 
 

Parent's Demographic Information

 
 
 
 
 
 

Parent's Contact Information

 

Street, City, State, Zip

 
Phone
 

If parent does not have an email address, please write noemail.com

 

Parent's Case Information

Information related to DHS case

 

The parent's ID number is required.

 
 
 
 

The county where you attend court concerning the DHS case. If county is not found, P2P Program does not serve the county.

 

Reason for involvement with DHS

 
 
 

Write date & time

 

List at least 3 goals

 

Date & Time

 
 
 

Date & Time

 

DHS Staff Information

 

The district the child welfare case in.

 

The region the child welfare case in.

 
 
Phone
 
 
 
Phone
 
 

Referring Information

 

What are the immediate resources and/or services the parent needs?

 

Why do you believe this parent would benefit from having a Parent Mentor?