Special Thanks to Genevieve & Glen Ghilotti

Special Thanks to Team Ghilotti

Special Thanks to Hunter Spencer

Special Thanks to Wm. H. Donner Foundation

Special Thanks to John & Carri Hammett

Special Thanks to Annual Event volunteers!

Special Thanks to Tom & Carol Wise

Special Thanks to Care.com

"Whether you think you can or whether you think you can't, you're usually right! "

Agency / Professional’s Survey

Questionnaire and/or client referral for those who serve special needs

Today's Date:

Your name & title/position:

Email:

Invalid format.

Phone:

Your agency / company’s name:

For profit company Non-Profit Organization Municipal/Government Agency

City:

State:

Please select an state.

National, sister and/or frequently associated agencies:

Check what applies:

I’m in the S.F. Bay Area and have a client who has an urgent need we hoped TLC could help address. If so, briefly describe that need. We understand confidentiality may prohibit use of client’s name but please include client’s age, diagnoses/condition & city of residence.

I’m with a like-kind agency and simply wish to connect and share ideas specifically in the area of:

Networking care providers and families with special needs
Camps and adventures for the disabled and/or their families
How we can work with care.com (special needs domestic employee search services)
Other:

How did you hear about TLC?

Give referring agency and worker’s name if applicable

and/or how you found our website?

Internet word(s) searched?

Do your agency’s services focus on any particular diagnoses/disability/condition and/or age range?

What types of services or resources do you offer those with special needs and/or their families?

From whom/how/why do clients connect with your agency (referrals, a funding agency, medical professionals, etc)

Would you be interested in attending Marin Respite and Childcare Collaborative (MRCC) meetings where agencies, and other stakeholders, gather to address the needs for respite within the special needs community? Our goal is to pool our knowledge and experience and then to supplement, rather that duplicate, efforts toward meeting the needs of families with special needs. We meet in Marin County of the S.F. Bay Area