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Allegheny Family Network Provider Referral Form

REFERRAL SOURCE INFORMATION

*Is the family CYF involved?
*Does the child have issues with truancy?
Is this referral due to the truancy concerns?
Has the SAIP Meeting been scheduled?
Has the school filed the truancy petition?
Is the individual interested in enrolling in our Adult Education (GED Program)?

REFERRED FAMILY INFORMATION

Is there an IEP in place?
Is there a 504 in place?

OTHER SYSTEM INVOLVEMENT INFORMATION

Thanks for submitting!
We’ll contact this person only in case of emergency.

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Allegheny Family Network Parent Support Line

1-888-273-2361

Parent Support Line offers a well-trained and experienced Family Support Partner with personal experience raising a child with behavioral issues who can help with connections to community services, negotiating different systems, or emotional support.  The families can also call to request a face-to-face one-on-one Family Support Partner through the Parent Support Line. Parent Support Line hours of operation are 9:00 am—4:30 pm Monday through Friday.  Calls received after hours will have the option of leaving a message and will receive a call back on the next business day. 

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* Parent Support Line is not a crisis line.  The Parent Support Line is a support line and referral service.  In the event of a crisis—AFN staff will refer callers to emergency support services such as 911 or Resolve Crisis Network. 

Allegheny Family Network

1501 Reedsdale Street Suite 2007  Pittsburgh, PA 15233  

EIN: 20-2080261 | Phone: 412-246-2030 | Fax: 412-246-0994

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