Free Listing for Special Education/ Special Needs related services in upcoming Jewish Press magazine

Tweet

There are 10 possible sections below to fill out. Please fill out all areas that apply. Much of the information is setup as checkboxes. You can type in Y for Yes for that.

To avoid errors please email the filled in word document. Email to resources@buildingblocksmagazine.com . You can also fax it to 347-342-3152.

They are:

Contact Information

Early Intervention approved programs (Ages birth to 3) __

CPSE Schools or Centers (Ages 3-5) __

CSE Schools or Centers (Ages 5-21) __

Therapy and Evaluation Services __

Camps __

Day Habilitation __

Residences __

OPWDD and other programs __

Advocacy __

Other __

…………………………………………………………………………………………….

1) Contact Information

 

Name of organization, school or camp: ___________________________________

 

Address: ________________________________________________________

 

Phone: _____________________

 

Website: ______________________

 

(These next 2 questions are for follow up purposes only)

Name of person completing this form_______________________

Contact#_________________

…………………………………………………………………………………………….

2) Early Intervention Approved Programs

 

Home Based __ Center Based __

 

ABA  ___Floor Time __ Sensory Integration  __ MEDEK __

Other (Please specify) ___________

Other services offered such as family counseling, play therapy, music therapy, parent support groups etc…___________________________________________________

……………………………………………………………………………………………..

3) CPSE Schools or Centers

 

Home Based ___ Center Based ___ Will send providers to private schools ___

 

State Approved ___ Privately Funded __

 

Population Served (Please check those that apply:)

Mild developmental delays ___ Moderate to severe developmental delays ___ Autism/PDD ___ Speech & Language impaired  ___ Learning Disabled ___

ADD/ ADHD ___ Emotionally disturbed ___ Hearing impaired ___

Visually impaired ___ Multiply handicapped ___

 

Please check the following services provided:

SEIT ___ OT ___ PT ___ Speech ___ Play therapy/counseling ___

 

What special training or services do you offer children?

ABA ___ Floor Time ___ Sensory Integration ___ MEDEK ___

Other (Please specify) ________

 

Bilingual Staff If yes list language(s)?_______________________________

………………………………………………………………………………………………

4) Schools – School Age (CSE 5-21)

 

State Approved ___ Privately Funded ___

 

Population Served

Mild developmental delays ___ Moderate to severe developmental delays ___ Autism/PDD ___ Speech & Language impaired  ___ Learning Disabled ___

ADD/ ADHD ___ Emotionally disturbed ___ Hearing impaired ___

Visually impaired ___ Multiply handicapped ___

 

Ages Served _________ Boys ___ Girls ___ Separate classes ___ Mixed classes ___

 

School Hours: _______________  Handicap Accessible ___

 

Bilingual Staff If yes list language(s)?_______________________________

 

Services offered:

ABA  ___ Floor Time ___ Pre-Vocational  ___ Other (Please specify) ____________

Are therapies provided on site? ___  List therapies provided _______________________________

 

Breakfast provided ___ Lunch provided ___  Meals Kosher ___

Is transportation provided? ___

Is transportation private ___ or through the Department of Education ___? ………………………………………………………………………………………..

5) Therapy and Evaluation Services

 

Home Based ___ Center Based ___ Will send providers to private schools ___

 

Ages Served ________________

 

Accept RSA’s ___ Accept P3s ___ Accept Insurance ___

If yes, please list which insurances are accepted: ____________________________

 

OT ___ PT ___ Speech/Language ___ Special Ed  ___

Do you conduct private evaluations? ___ Other Services ______________________

 

Handicap Accessible ___ Bilingual (list languages)_____________

 

Population Served:

Mild developmental delays ___ Moderate to severe developmental delays ___ Autism/PDD ___ Speech & Language impaired  ___ Learning Disabled ___

ADD/ ADHD ___ Emotionally disturbed ___ Hearing impaired ___

Visually impaired ___ Multiply handicapped ___

 

Services offered:

ABA ___ Floor Time ___ Sensory Integration ___ MEDEK ___

Other (Please specify) __________________________________________

………………………………………………………………………………………..

 

6) Camps and End of Summer Programs

 

Duration, # of Weeks _______  Day camp ___ Sleep away camp ___

 

Location of Camp: ____________________________________________

 

Ages Served: ______________  Male ___ Female ___ Separate ___ Mixed ___

 

Population served:

Mild developmental delays ___ Moderate to severe developmental delays ___ Autism/PDD ___ Speech & Language impaired  ___ Learning Disabled ___

Fatal error: Call to undefined function upm_print() in /hsphere/local/home/jewishpress/jewishpress.com/wp-content/themes/jewishpress/single_part-no_column.php on line 33