Request for Parent Mentor

If you are a parent of a child with a disability and would like to be put in touch with other parents who have a child with the same disability or medical condition, please fill out the “request for mentor” application form. All information is confidential. It is for internal use only to provide as accurate a match as possible. We only supply contact information, the name of your child, and the diagnosis to our mentor parent. It is up to you to decide what other information to share. After submitting your request, you should hear from us within 3-4 days.

Your Contact Information

Information about your child

Yes No

Yes No

Street address

Parent to Parent of SW MI
406 E. Michigan
Kalamazoo 49007

Phone number

Phone: (269) 345-8950
Fax: (269) 345-5363