Families Interested in the Mentor Program

Families Interested in the Mentor Program
The SOC Mentor Program is a free program offered to families of children who are deaf or hard of hearing, ages birth to age 5. It gives families the opportunity to meet deaf and hard of hearing adults with different experiences and varying backgrounds. Mentors meet with each family on a regular basis, either at the family home or remotely, to provide them with a positive and hopeful perspective from their day-to-day, real-life experiences as a deaf person living in a hearing world.

Mentors are trained in American Sign Language (ASL) instruction and interact with children and families using ASL. Mentors will show family members how to use ASL through both informal interactions and more formal ASL lessons. They will also share information about deaf culture and introduce the family to the local Deaf community.

Commitment
Can your family make a one-year commitment to this program?*

YesNo
If you do not think you can make a one-year commitment, how long can you commit to working with this program?*

3 months6 months9 months

Collaboration
Your Mentor will also collaborate with ECI, your teacher for the deaf through ECI, or you child's school based team (for children ages 3-5 years). ECI or the school district will request your written consent to have this collaboration.
Are you willing to have your Mentor collaborate with your ECI team (for children birth-3)?*

YesNoMaybe
Are you willing to have your Mentor collaborate with your school-based team (for children 3-5 years)?*

YesNoMaybe

Daily Life, Interests, and Activities
Please answer the information below. This will help us match you with a Mentor.
Please tell us about your child's daily routine, both Monday - Friday and on the weekends. We know sometimes routines change, but please tell us what you and your child usually do on these days. You can organize it by times of day, or just generally tell us what you do.*
What are some activities your child enjoys doing?*
What are some activities you and your family enjoy doing? Please include things you do both at home and outside of the home.*
Are there any other specific things you would like us to know about your family or your child?*

Availability
Because Texas is such a large state, some of our services will be face-to-face in your home, and some will be remote through services such as ZOOM, FaceTime, or other technology tools. Please answer the following questions about your availability and the days/times that will work best for your family.

Please tell us the top 4 days of the week that would be best for your family to meet with a Mentor.*

Please tell us the best times of day to meet with your family for each of your four choices.*

If we do not have a Mentor in your immediate area, are you willing to have meetings remotely (ZOOM, FaceTime or other technology tools?*

YesNo
Are you comfortable using remote technology to meet with Mentors? (e.g., ZOOM, FaceTime or other technology tools?*

YesNo
What kind of technology do you have available to you for remote services? (check all that apply)*

Computer (desktop with webcam or laptop)TabletVideophoneCell Phone
Do you have internet access in your home?*

YesNo

Additional Information
Is there any other information you want to share with us about you, your child, or your family?
Are you currently receiving services from other programs?*

YesNo
Which program(s) are you currently receiving services from?*
How did you hear about our Mentor program?*

Thank You!
Thank you for the information you have given us today. This will help us match you with a Mentor to begin working with your family.

If you have any questions, or additional information to share, please contact us at dhhm@tsd.state.tx.us.
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