Family Voices of Washington is a program of PAVE. Helpful tips while you wait:Share the best phone number and time of day to reach you. Your request may generate referrals to more than one program of PAVE! This is to better serve you and your family’s needs.Please check your email and voicemail if you have not heard from us.For emergency issues please call 911 and to protect vulnerable children and adults:Child Protective Services [1-866-ENDHARM or 1-866-363-42760]Adult Protective Services [1-877-734-6277] Nationwide Suicide & Crisis Lifeline [call or text 988]Completing the help request: All fields marked with an asterisk* are required. Choose your roleFill out your informationCheck the box that you are not a robotClick submit and we have received your form!Essential information is your name, a phone numbers and email address. What if you don’t have all of three of those? Please call 1-800-572-7368 and then press 115 to leave a message.Help Request FormPlease fill out the information below: Click your role below Parent/CaregiverYouth Self-AdvocateAdult Self-AdvocateProfessionalContact Information First Name Last Name Email Phone Can we text you at the above phone number?Please select...YesNo Organization Name My Gender IdentityPlease select...FemaleMaleTrans WomanTrans ManNon-Binary or GenderqueerAgenderOtherPrefer Not to Answer My PronounsPlease select...She/HerHe/HimThey/ThemOther My Sexual OrientationPlease select...Heterosexual or StraightGayLesbianBisexual or PansexualOtherPrefer Not to Answer My Birthdate CountyPlease select...AdamsAsotinBentonChelanClallamClarkColumbiaCowlitzDouglasFerryFranklinGarfieldGrantGrays HarborIslandJeffersonKingKitsapKittitasKlickitatLewisLincolnMasonOkanoganPacificPend OreillePierceSan JuanSkagitSkamaniaSnohomishSpokaneStevensThurstonWahkiakumWalla WallaWhatcomWhitmanYakima My primary language is Please select...EnglishSpanishRussianVietnameseSomaliUkranianChineseChinese-CantoneseChinese-MandarinChinese-UnspecifiedKoreanTagalongArabicPunjabiCambodianMarshalleseSamoanAmharicJapaneseRumanianFrenchNepaliMixtecoLaoHindiSign LanguageOtherWe ask this to better serve you in your preferred language, as possible. x Other primary language My ethnicity (optional)Please select...Hispanic or LatinoNon-Hispanic or Non-LatinoUnknown My race is (Check all that apply. Optional.)Caucasian/WhiteBlack or African AmericanAmerican Indian/Native American/Alaska NativeAsianPacific Islander/Native HawaiianTwo or more racesUnknownI would like to refer a self-advocate, family, and/or parentSelf-Advocate/Child/Family Member InformationPlease provide information about the main family member that you are contacting PAVE about today. Please describe your relationship to the child/family member:Please select...SelfMy child/stepchild/foster childMy sibling with a disabilityAnother relativeFriend or child of friend Child/Family Member First and Last Name Gender IdentityPlease select...FemaleMaleTrans WomanTrans ManNon-Binary or GenderqueerAgenderOtherPrefer Not to Answer PronounsPlease select...She/HerHe/HimThey/ThemOther Sexual OrientationPlease select...Heterosexual or StraightGayLesbianBisexual or PansexualOtherPrefer Not to Answer Disability Category/EligibilityPlease select...Unknown/UndisclosedAutism SpectrumDeaf-BlindnessDeafHearing ImpairmentDevelopmental Delay (Early Childhood)Emotional DisturbanceIntellectual DisabilityMultiple DisabilitiesOrthopedic Impairment (physical)Other Health ImpairmentSpecific Learning DisabilitySpeech or Language ImpairmentTraumatic Brain InjuryVisual Impairment including BlindnessSuspected/Not Yet IdentifiedMay be inappropriately identified Birthdate Format as mm/dd/yy x Primary languagePlease select...EnglishSpanishRussianVietnameseSomaliUkranianChineseChinese-CantoneseChinese-MandarinChinese-UnspecifiedKoreanTagalongArabicPunjabiCambodianMarshalleseSamoanAmharicJapaneseRumanianFrenchNepaliMixtecoLaoHindi Child/Family Member's race (Check all that apply. Optional)Caucasian/WhiteBlack or African AmericanAmerican Indian/Native American/Alaska NativeAsianPacific Islander/Native HawaiianTwo or more racesUnknown Child/Family Member ethnicity (optional)Please select...Hispanic or LatinoNon-Hispanic or Non-LatinoUnknown My primary reason for contacting PAVE today isPlease select...learning and schoolparent and familyhealth and wellnessyouth (ie disability pride, leadership, my life/my plan)resourcescommunity eventsrespite (Lifespan)other Other Other topics I would like to discuss (optional)learning and schoolparent and familyhealth and wellnessyouth (ie disability pride, leadership, my life/my plan)resourcescommunity eventsrespite (Lifespan) Please let us know a little bit about why you are contacting PAVE today (500 character maximum) Would you like to sign up for our e-newsletter?Please select...YesNo Thanks! That's all we need! It is the policy of PAVE to provide support, information, and training for families, professionals and interested others on a number of topics. In no way do these activities constitute providing legal advice. PAVE is not a legal firm or a legal services agency. Phone interpretation available -- Interpretación telefónica disponible -- 提供電話口譯 -- 전화 통역 가능합니다 -- Доступен перевод по телефону -- Waan kuu heli karnaa turjubaan telefoon ah -- Có sẵn dịch vụ thông dịch qua điện thoại -- توفر خدمة الترجمة الفورية عبر الهاتف reCAPTCHA helps prevent automated form spam.The submit button will be disabled until you complete the CAPTCHA. Contact InformationShare this:TwitterFacebook
