Our mission is to assist exceptional children by providing needed resources, tools, and programs.
To better assist you please fill out this survey and mail or fax.
Name________________________________________________
Address_____________________________________________
Phone Numbers: Home___________________Work_______________
E-mail________________________ Fax______________________
Special needs children are children who experience difficulties in learning and children whose performance is so superior that special education is necessary to help them fulfill their potential.
Please check your child's characteristic(s):
__Mental Retardation (learn at a rate below other children of the same age)
__Learning disabilities (cannot receive, understand or express information)
__Behavior disorders (emotional disturbance)
__Communication disorders (speech & language problems)
__Hearing impairments
__Visual impairments
__Physical and other health impairments
__Severe disability
__Gifted and talented
Please answer the following questions:
1. What are your main concerns or needs.
2. What programs or resources are you presently using to assist your child?
3. Would you be interesting in attending workshops or seminars? What times would you prefer?
4. Would you like to become actively involved in the foundation?