TACA Talk About Curing Autism - TACA Mentor Application

TACA Mentor Application

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

Questions? Contact Becky.

Overview:

TACA – A California not for profit 501(c)3 organization established in 2000 – is looking to help more families affected by autism via our volunteer mentor program. TACA is in great need to expand this program in our existing service area – California and through the remaining 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

We recommend you take a look at the current TACA Volunteer mentor program and understand how we position this free service to families in need.

Please visit:

Mentor Guidelines

Mentor Program Frequently asked questions

Parent Mentor agreement

Thank you for taking the time to review, fill out and consider being a TACA mentor. WE TRULY VALUE YOUR DESIRE TO HELP. I will be contacting you within the next 14 business days to follow up on your application and upcoming mentor training.

Sincerely,

Becky Estepp

National Parent Liaison

Applicant Name:
Last, First

Home Street Address:

Home City:

Home State:

Home Zip

Telephone Number:

email address:

School District:

Do you have a child with Autism Spectrum Disorder living with you? yes or no

If yes, child's age; if no, put N/A:

When was your child diagnosed?

How many children with autism live with you?

How many neurotypical children live with you?

If you participate in any other autism support groups please list them:

Autism Knowledge

To the best of your ability, please rate your “autism knowledge.” Having an advanced competency across all areas below is not required to be a TACA Mentor – in fact – we often assign mentors BY TOPIC, not by overall knowledge! It is important to be honest about your abilities in the areas below so we can gauge the needs by potential chapter. Thank you.

Have you attended a DAN! conference?

Indicate cities and years did you attend a DAN! conference:

What other autism related conferences have you attended? Please indicate the year of attendance.

Have you sat in on the DAN! medical pre-conference doctor or nurses training days? Please indicate year.

Please rate your knowledge from a 1 to a 10 with 1 being no knowledge in a particular area and 10 being used only as the highest level of confidence. For example if you provide regular lectures on a topic or have extreme comfort of knowledge in a particular area. Individuals who have attended more than four DAN conferences should rate their knowledge somewhere between a 7 and 9.

Dietary intervention Please indicate diet(s) you use:

DAN! biomedical protocols

Payment resources to help families (state, federal & health insurance)

Prescribed medications (please indicate the medications you use)

Legal issues

Supporting families affected by autism

Organization and planning

Supplementation

Traditional therapies (speech, OT, one on one interventions)

Public speaking / presentation comfort level

Indicate other topics here:

Please rank the topics above you feel the most comfortable in assisting a new parent:

Mentor Preferences

You are almost done. TACA wants to make sure we best match mentees to mentors by the following preference information.

How many mentees would you like to receive - maximum?

Per month?

Per year?

We do mentor introductions via email – what would be your favorite way to communicate with your new mentee family?
ex. email, phone, in person

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How TACA Helps Families

› Adopt a Family Recap
› Family Scholarship Program
› AutismCares Family Support Awards
› Parent-to-Parent Mentoring

Year-round assistance to families in great need.

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Laird Hamilton Wonderwall Surf and Skate Gear

Surf and skate line includes unique tee that will benefit Autism Awareness & help for families

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Just for FUN – once a month

Come join your TACA friends at PUMP IT UP in Huntington Beach, Rancho Cucamonga and Sorrento Valley for some good ol’ family fun! See schedule