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Stone Soup Group

Supporting Alaskan Families who care for children with special needs.

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Submit an Online Intake

307 E Northern Lights Blvd #100
Anchorage, AK 99503
Map & Directions

Phone: (907) 561-3701
Toll Free: (877) 786-7327

Stone Soup Group Online Intake Form

This form is for individuals requesting support for themselves, their children, their families, or friends. This form is not for professionals referring a family. If you are a professional who wants to refer a family, please use our Referral Form. Click here to access the Referral Form.

I am contacting you about:

my child, family member or person with disabilitymyself

Your Information

First Name

Last Name

Mobile Phone

Would you like to receive text messages?

Yes

No

select "Yes" to receive SSG updates, newsletters, event notifications and promotional information via text message

Email

Would you like to be added to our mailing list?

Yes

No

select "Yes" to receive SSG updates, newsletters, event notifications and promotional information via email

Street Address

City

State

Zip

Borough/Region

Your Birthdate

Preferred Language

Race/Ethnicity

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoPacific IslanderSome Other RaceWhitePrefer not to disclose

What insurance do you have?

Medicaid/TEFRA/Denali KidCareMedicareTricarePrivateOtherUninsured

Are you and/or your family affiliated with the military?

Yes, active militaryYes, reserve & guardYes, veteran/retiredNo military affiliation

Which branch of the military?

ArmyAir ForceCoast Guard

Are you in contact with your EFMP (Exceptional Family Member Program)?

YesNo

Disability (select all that apply)

ADD/ADHDAutismBehavioral/Mental HealthCerebral PalsyCleft Lip/PalateCognitive ImpairmentDevelopmental DisabilityEmotional DisabilityEpilepsyHearing ImpairmentLearning DisabilityNeurologicalOrthopedicPhysical DisabilityRare/Genetic DiseaseSpeech/LanguageTraumatic Brain InjuryVision ImpairmentOther/Unknown/Suspected

Child/Family Member/Person with Disability Information

Relationship to Child/Person

Is Child/Family Member/Person their own guardian? [for ages 18+]

YesNoI don't know

First Name of Child/Family Member/Person

Last Name of Child/Family Member/Person

Birthdate of Child/Family Member/Person

Gender of Child/Family Member/Person

MaleFemaleNon-binaryOther

Race/Ethnicity of Child/Family Member/Person

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoPacific IslanderSome Other RaceWhiteUndisclosedUnknown

What insurance does the Child/Family Member/Person have?

Medicaid/TEFRA/Denali KidCareMedicareTricarePrivateOtherUninsured

Child/Family Member/Person Disability (select all that apply)

ADD/ADHDAutismBehavioral/Mental HealthCerebral PalsyCleft Lip/PalateCognitive ImpairmentDevelopmental DisabilityEmotional DisabilityEpilepsyHearing ImpairmentLearning DisabilityNeurologicalOrthopedicPhysical DisabilityRare/Genetic DiseaseSpeech/LanguageTraumatic Brain InjuryVision ImpairmentOther/Unknown/Suspected

Specifically, I would like more information or support on...

Parent Resources, Support and/or TrainingSchool Related SupportHealthcare Information and AssistanceDDRC/Medicaid Waiver*Please select the highest area of need at this time. When you have met with a Navigator they will help with any other concerns you have.

MAP (Mentor, Advocate, Partner) Program and Compass Group
The MAP Program offers parent mentoring that can provide an emotional shoulder to those caring for a child with special needs. The Compass Group is a non-therapeutic support group that meets monthly as part of the MAP program and is available for participating parents.

I am interested in learning more about the MAP Program and Compass Group:

YesNoThe Program Coordinator will contact you via email regarding the program.

Additional Information/Comments:

*Please allow up to 3-5 business days for your online intake request to be processed

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Contact Information

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Parents & Families

Find assistance with school, health care or behavior related issues through Parent Navigation, or be connected with other families in similar situations.

Training & Events

If you are a parent, professional or youth with special needs, Stone Soup Group offers year-round activities and training to help you gain skills and connect with others in our community.

Community

Let your voice be heard. Join various community opportunities and speak your mind about the issues facing children and youth with special needs and the families who care for them.

Find a Provider

Google will tell you who is in our community, but it can’t tell you whether other families would recommend them. We can help you find recommendations from other families, along with other details like what insurance plans are accepted.

Stone Soup Group 307 E Northern Lights Blvd #100 Anchorage, AK 99503 · Directions and Map
Phone: (907) 561-3701 · Tax ID: 92-0149995
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