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1. Connect with a Family Support Specialist:

A Family Support Specialist is a staff member at ASK who is trained to help with health care and education issues related to disability. If you have specific questions about health or disability and need information, support, or advocacy, choose this option.

2. Request ASK to attend an exhibit fair or to provide a training:

Choose this option if you want ASK to attend an exhibit fair or if you would like us to provide training for your company, team, support group, conference, or other events.

3. Request a mentor or to become a mentor:

A mentor is a trained volunteer who has experience caring for an individual with a disability. Choose this option if you are looking for a listening ear who has “been there” and can offer support and encouragement. You may also use this link to become a mentor yourself.

All services provided to people with disabilities and their family members are FREE. Services to professionals are low to no cost.

Please choose from the following

Please complete the information below. All information submitted goes to a confidential database and will not be shared. We will contact you in the order that requests are received. You will receive an email once you submit your request.

What is your role?

Parent/ Guardian, Family Member

Self-Advocate

Professional Referring a Parent or Person with Disability

Professional Requesting Support

Contact Name (first and last):

We will make at least 3 attempts to contact you which could include phone, text or email. By providing your contact information you understand that we may use that information to reach you.

Contact Phone Number:

Contact Email Address or an alternate option such as a second phone number or mailing address:

Our Family Support staff will call you to discuss details of your intake.

Preferred time to be reached between 8AM-4PM (If you need a call back outside of our business hours we can schedule a time with you.):

Do you need an accommodation to access our services?

Submit the information below about the child/ person with disability that you are contacting ASK about.

Child/ Person with disability's Name:

Child/ Person with disability's Month and Year of Birth:

Child's School District:

Reason for Contact (select all that apply):

Health

Education

Community Resources

Other

Other:

Additional information about your reason for contact:

Please upload any documentation that you would like to share.

Please check this box if you DO NOT want to receive our monthly E-Newsletter

Your Name (first and last):

We will make at least 3 attempts to contact you which could include phone, text or email. By providing your contact information you understand that we may use that information to reach you.

Your Phone Number:

Your Email Address or an alternate option such as a second phone number or mailing address:

Our Family Support staff will call you to discuss details of your intake.

Preferred time to be reached between 8AM-4PM (If you need a call back outside of our business hours we can schedule a time with you.):

Do you need an accommodation to access our services?

Your Month and Year of Birth:

Your School District (if applicable):

Reason for Contact (select all that apply):

Health

Education

Community Resources

Other

Other:

Additional information about your reason for contact:

Please upload any documentation that you would like to share.

Please check this box if you DO NOT want to receive our monthly E-Newsletter

Professional Name (first and last):

Job title:

Doctor/ Nurse

Therapist/ Counselor

Social Worker/ Case Manager

Service Provider

School Professional

Legal Professional

Other

Other:

Organization Name:

We will make at least 3 attempts to contact you which could include phone, text or email. By providing your contact information you understand that we may use that information to reach you.

We will only reach out to you if we are unable to make contact with the parent or individual with disability. By providing your contact information you understand that we may use that information to call, text or email you.

Professional Phone Number:

Professional Email Address:

Yes, I have notified the family/ person with disability that their information has been submitted to ASK Resource Center. ASK may use this information to contact them which could include phone, text or email. We will make at least 3 attempts to contact the parent or person with disability:

Upload a SIGNED Release of Information (optional)

Submit the information below about the family/ Person with disability that you are contacting ASK about.

Parent/Person with Disability Contact Name (first and last):

Parent/Person with Disability Contact Phone Number:

Parent/Person with Disability Contact Email Address (if you cannot provide an email address please provide a second way to reach the family/person with disability):

Our Family Support staff will call the parent/ person with disability to discuss details of the intake.

Preferred time to be reached between 8AM-4PM (If a call back is needed outside of our business hours we can schedule a time.):

Are any accommodations needed by the parent/ person with disability to access our services?

If you are referring a parent, please complete the section below about their child (optional)

Child's Name:

Child's Month and Year of Birth:

Reason for Contact (select all that apply):

Health

Education

Community Resources

Other

Other:

Additional information about your reason for contact:

Child's School District

Please upload any documentation that you would like to share.

Please check this box if you DO NOT want to receive our monthly E-Newsletter

Our Family Support staff will call you to discuss details of your intake.

Preferred time to be reached between 8AM-4PM (If you need a call back outside of our business hours we can schedule a time with you.):

Do you need an accommodation to access our services?

Reason for Contact (select all that apply):

Health

Education

Community Resources

Other

Additional information about your reason for contact:

Please upload any documentation that you would like to share.

Please check this box if you DO NOT want to receive our monthly E-Newsletter

By providing my contact information, I acknowledge and give my explicit consent to be contacted via SMS. Message and data rates may apply. Message frequency may vary. Reply STOP to opt out.

Request (select all that apply):

Training

Resource/Exhibit Fair

Contact Name:

Organization:

By providing your contact information you understand that we may use that information to reach you.

Contact Email Address:

Contact Phone:

Preferred method of contact (select all that apply):

Email

Phone

Event Name:

Event Date and time:

Event Location - Virtual or Address of Event:

Expected number of participants:

Other Event Details:

Please upload any documentation that you would like to share.

Please check this box if you DO NOT want to receive our monthly E-Newsletter

By providing my contact information, I acknowledge and give my explicit consent to be contacted via SMS. Message and data rates may apply. Message frequency may vary. Reply STOP to opt out.

What is your mentoring request?

Contact Name (first and last):

We will make at least 3 attempts to contact you which could include phone, text or email. By providing your contact information you understand that we may use that information to reach you.

Contact Phone Number:

Contact Email Address or an alternate option such as a second phone number or mailing address:

Our Family Support staff will call you to discuss details of your intake.

Preferred time to be reached between 8AM-4PM (If you need a call back outside of our business hours we can schedule a time with you.):

Do you need an accommodation to access our services?

Additional information about your reason for contact:

Become an ASK Each Other Mentor

ASK Each Other Mentors share lived experiences about disability with others. Mentors share stories, answer questions, provide unbiased information, share community connections and give emotional support. Free training is provided along with opportunities to connect and learn with other mentors.

Who can become a Mentor?
1. a Parent, Guardian/Caretaker, or Sibling of a person with a disability or special health care need
OR
2. an Individual with a Disability or special health care need

Steps to become a Mentor

A Family Support Specialist will contact you by phone or email to discuss completing the following:
1. Conflict of Interest form
2. Mentor Information form
3. ASK Each Other Mentor Training
4. Background Check

For questions or to become a mentor, complete the information below.

Contact Name (first and last):

City that you live in:

We will make at least 3 attempts to contact you which could include phone, text or email. By providing your contact information you understand that we may use that information to reach you.

Contact Phone Number:

Contact Email Address or an alternate option such as a second phone number or mailing address:

Our Family Support staff will call you to discuss details of your intake.

Preferred time to be reached between 8AM-4PM (If you need a call back outside of our business hours we can schedule a time with you.):

Do you need an accommodation to access our services?

Why do you want to be a Mentor? (Briefly describe any special skills or experiences):

By providing my contact information, I acknowledge and give my explicit consent to be contacted via SMS. Message and data rates may apply. Message frequency may vary. Reply STOP to opt out.