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The Special Connections Community Survey
Our mission is to serve and uplift special need families holistically, recognizing the inherent potential in every individual. We are dedicated to empower individuals and care givers through curated events, programs, and tailored resources, driven by our passionate special needs community.
Sign up to stay informed for all future communications and events. Share your thoughts to help us serve you better.
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Name
*
Your answer
Email Address
*
Your answer
Would you like to subscribe to all future communications and events by The Special Connections?
Yes
No
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Are you a parent/caregiver or individual with special needs?
*
Parent / Caregiver
Individual
Which of the below programs are you interested in?
Social Event: Sensory friendly social gathering for individuals to learn and play
Support Group: Informal gathering for care givers to share experiences
Learning Workshop: Education session on specialized topics related to education, nutrition, therapies etc. from professionals and care givers
Info Session: Sharing information and resources available for special need individuals and families
Buddy Program: Social mentoring and developing friendship with special need individuals
Summer Camp
Family Picnic
Which of the below topics are you interested to learn about?
School Education (IEP, Special Needs school, etc.)
Nutrition (Special diets, protocols etc.)
Therapies and their benefits (ABA, MNRI etc.)
Financial Planning (opening Trust, Will, state benefits etc)
Heartfulness Meditation for Parents
Other:
What services does the special need individual avail currently?
ABA
Speech
Occupational Therapy
Physical Therapy
Music
Sports Events
Other:
What additional therapies or services are you looking for the special need individual?
Your answer
Please share your thoughts, suggestions, feedback and concerns that can help us serve you and the community better.
Your answer
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