🤝 Know a Family Who Needs Support?

Growing Our Community Starts With You — Help Us Reach More Families

Have you benefited from the support, resources, or community at California Hands & Voices? Or do you work closely with Deaf and Hard of Hearing (DHH) children and their families? We’d love your help! We don’t receive automatic referrals. Instead, we rely on the trusted recommendations of individuals like you to help families discover the vital support we offer.

Every referral makes a difference. When you refer a family, you’re opening the door to:

💬 One-on-one parent-to-parent support
📂 Access to trusted resources and non-judgmental support
🏕️ Local events, Family Camp info and much more
📚 Educational advocacy through our ASTra Program

Referring a family is easy—and it makes a big difference. Once you submit the form below, we’ll send a warm, personalized Welcome Email with helpful tools and friendly connections to get them started.

💙 Together, we can make sure no family walks this journey alone.

Stronger Together: Partnering With Professionals to Support Families

Whether you’re a service provider, educator, or healthcare professional, we welcome your ideas and input. Please feel free to reach out to our Board President, Executive Director, or your regional representative to explore how we can work together to best support the families you serve.

Together, we’re creating a community where every family is supported, informed, and empowered.

“Alone we can do so little; together we can do so much.” Helen Keller

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Family Referral Form

We can use your help in identifying families who could benefit from connecting to another parent.

If you know of a family who would value a connection, please refer them to us through this form, after gaining permission from the parent.

Referral Source

Referring Individual/Organization *

Role of Referring IndividualSelect from list…Self ReferralAnother ParentAudiologistENTHands & VoicesHearing Coordination Center (HCC)Early Start (0-3 years old)School District (3+ years old)LEAD-K Family ServicesParent CenterRegional CenterFamily Resource CenterOther

Phone *

Email *

Family Contact Information

Parent's Full Name *

Phone *

Email *

County *Select County…AlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYubaOut of State

Primary Language of Parent *EnglishSpanishASLOther

You may select multiple languages

EthnicityChoose from list…African American / BlackAsianHispanic / Latino;Native Hawaiian / Pacific IslanderNon-WhiteWhiteUnknown / Decline

This information is helpful for grant writing, but purely optional

Reason for Referral

Family Interested InChoose one topic…AdvocacyAuditory NeuropathyAmerican Sign LanguageAtresiaAuditory ProcessingBilingual Education / CSDCollege / VRConnexin 26/30Cued SpeechDeaf BlindEarly StartEventsHearing Tests/AudiogramIDEAIEP/IFSPListening Spoken Language / SchoolsLocal Deaf AgencyMeeting a DHH AdultMental HealthMinimal Hearing LossMondiniMultiple DisabilitiesOnline Social GroupsOT/PTOther (see Other Info box)Parent Links / Meet local familiesResearch (contact family)Signing Exact EnglishState/National OganizationsTechnologyTotal CommunicationTransition

Select the topic that the family is MOST interested in. Enter any other topics in the Additional Information field

Additional Information *

Signature and Date

Your signature below confirms that you have permission from the parent to make this referral

Signature of Referring Individual *

Clear Signature

Date of Referral *

Submit Referral