Interest Form for DSAW 1:1 Services
Thank you for your interest in DSAW's 1:1 services this fall. Please fill out the information below, and someone will contact you soon. Thanks!
Email *
Parent/Guardian Name *
Client Name *
Client Age *
Phone *
Address *
Day and Time Preference *
Number of hours during each 1:1 session *
Services
Please respond to all that apply below.
I want my son/daughter to work on 1:1 skills within my home, doing some of the following activities:
I want my son/daughter to work on 1:1 skills in the community, doing some of the following activities/locations:
I want my son/daughter to find fun volunteer experiences in the community, such as:
Best time to have a DSAW employee call you to further discuss the above services/details:
A copy of your responses will be emailed to the address you provided.
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