Family Navigation Interest Form

EnCompass Family Navigation is a free, voluntary program for families living in the City of Rochester in Rochester offering support to enhance your child's success at home, in the community, and at school. Our navigators aid in fostering effective communication with school staff, connect you to community resources tailored to your family's needs, and host events that foster connections with parents in your child's school community.

Interested? Fill out our quick interest form, and a navigator will be in touch soon.

Do you currently live in the City of Rochester?

Yes

In order to quality for Family Navigation, you must live within the City of Rochester.

How did you hear about Family Navigation?

If from an individual please include their first & last name.

Family Home Address

Family Address

Parents/Guardians

Parent/Guardian 1

Relationship to children

Parent/Guardian 1

Mother

Father

Other:

Preferred Language

Parent Guardian 1

English

Spanish

Other:

Primary Phone

Parent/Guardian 1

Secondary Phone

Parent/Guardian 1

Parent/Guardian Email

Parent/Guardian 1

Is there a 2nd parent/guardian?

Yes

Parent/Guardian 2

Relationship to children

Parent/Guardian 2

Mother

Father

Other:

Preferred Language

Parent/Guardian 2

English

Spanish

Other:

Primary Phone

Parent/Guardian 2

Secondary Phone

Parent/Guardian 2

Parent/Guardian Email

Parent/Guardian 2

Children in the Family

How many children are in your family? Enter the number of children by age group in the boxes below:

Age 0-4

Age 5-8

Age 9-12

Age 13-15

Age 16-18

Please Upload a copy of your students' most recent report card if available.

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Please enter all the children under 18 in your family below. Click the "add another child" button to add more children.

Child's Name

DOB

YYYY

Gender

Male

Female

Other:

Please select

School

If child is not enrolled, write "none"

School ID

Check any support services child receives:

IEP

504 Plan

ESL

To add another child, click the "Add Another Child" button below ↓

Interest in Family Navigation

Are any of these factors concerns you have about your family?

No, this is not a concern

Not sure

Yes, this is a concern

School Related Needs

Basic Needs

Family Engagement

What Family Involvment do you hope to build?

Select allClear choices

Parenting Programs (Parent Power Hour, Parenting Classes)

Family Events (Edible Education, Harvest Fest, Winter Holiday Event, End of School Bash)

Building Your Community

Other:

What other community programs are you currently working with?

Examples include but not limited to: Children's Health Homes, Adult Health Homes, Preventative Services, etc.

Briefly describe why you are interested in the Family Navigation program at EnCompass:

Please upload any Report Cards or IEP/504, etc documents that you have

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Choose files or drag here