Volunteer Interest Form

Please complete this form if you are interested in volunteering directly with PPMD. We rely on dedicated families and community members like you to help us reach all communities in Maryland with resources, support, and information about special education, health, and behavioral health (including mental health, substance use, and problem gambling).

Please provide your contact information:

First Name

Last Name

Phone

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip Code

County of Residence

Now, tell us a bit more about yourself:

The following questions help PPMD to ensure we are reaching everyone in our community and to receive grants to fund our programming. Many questions have the option of "prefer not to answer" if you wish to not provide that information to us.

Thank you for understanding and providing the following information so we can get to know you a bit better.

Please describe yourself. (Check all that apply.)

Parent/GuardianOther relativeStudent/youthProfessional

Please list the organization you work for.

What is your race?

What is your ethnicity?

What are is the age of your child(ren)?

Please list any disabilities or diagnoses your child(ren) has:

Do you have a child or young adult who would be interested in volunteering alongside you?

YesNo

Please tell us the name of your child or young adult who is interested in volunteering and a good email address for them (if available). We welcome volunteers of all abilities!

Contact Information