CPAC Connecticut Parent Advocacy Center
Connecticut's Resource for Children with Disabilities Connecticut Parent Advocacy Center Connecticut Parent Advocacy Center
Connecticut's Resource for Children with Disabilities;
Empowering and Educating Families

Match Request

Online Match Request Form

Interested in receiving support from a Parent Mentor? Fill out our online match request form below and one of our Early Childhood Parent Consultants will contact you within 24-48 hours.

Please note that an asterisk (*) indicates required information.


How did you hear about Family Connections at CPAC?


If you selected Other, please provide details:


Primary Caregiver Information
* First Name


* Last Name


Primary Language


Home Phone


Cell Phone


Best time to call


* Email address


Street address


City


State and Zip Code



Child's Information
* First Name


* Last Name


Date of birth


Gender


Age at diagnosis


Primary diagnosis


Secondary diagnosis


Name of your Birth to Three Agency


* Please give a detailed description of your concerns/reason for requesting match:


Other CPAC Programs

Match Request

Match
Request

Interested in receiving support from a Parent Mentor?

Support Another Parent

Support Another Parent

Interested in helping support another parent of a child with a developmental delay/disability?

Meet our parent mentors

Meet our parent mentors

Meet our parent mentors and connect with them!

Parent Mentor Portal

Parent Mentor Portal

Online training modules, job description, Q&A, and more...

Training
Resources

Training for Families and Professionals

Your Child's Development

Child
Development

Sparkler App and other resources

Communicating Your Child's Needs

Communicating Needs

Techniques for communicating your child's needs to professionals

DEC Recommended Practices

DEC
Practices

Division of Early Childhood (DEC) Recommended Practices

Learning Series

Learning Series

Learning Series with Early Childhood Professionals

Family's Stories

Family Stories

Watch videos to learn more about some Connecticut family stories

Developmental Games

Games

Developmental Games for preschoolers and young children

aRPy

aRPy

Meet CPAC's aRPy Ambassdors