Please select all applicable services

Intent of the Website:

The ThinkDIFFERENTLY! website embodies Dutchess County’s commitment to build a community where people with special needs are seen as we see our neighbors - People with abilities.

Purpose of this Survey:

The Dutchess County Office for Special Needs is assembling a web-based directory of services and supports for people with all abilities and their families.

The goal of the website is to be a resource that can help guide individuals with a variety of special needs and/or their families toward services that they need or may not know are available.

Directions:

Please complete all or any of the sections that your agency would like to have information represented on ThinkDIFFERENTLY website. Including the services that your agency/program provides, and the main office address (with zip code) so that individuals can locate you. You will have an opportunity to provide additional services or programs that your agency/program provides that are not captured in our listing.

The person completing this survey must be the person with the ability to authorize the information about your agency/program on the ThinkDIFFERENTLY! website. Be sure to review your information prior to submitting this survey.

* = Required Field

Would you like to add your organization or edit details? (required)

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1. Would you like to add your organization or edit details? (required)

Name of your organization (required)

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2. Name of your organization (required)

Your full name (required)

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3. Your full name (required)

Your phone (123-123-1234)

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4. Your phone (123-123-1234)

Your email address

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5. Your email address

Preferred method of communication

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6. Preferred method of communication

Name/Type of Program and Location of Services (Add the location for where you provide actual services for example: Abilities First Day School  or Abilities First Residential Services )

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7. Name/Type of Program and Location of Services (Add the location for where you provide actual services for example: Abilities First Day School  or Abilities First Residential Services )

If your organization has an events calendar on the web, please provide a URL (example: www.dutchessny.gov/concalendar/calendar.aspx?viewtype=calendar&munipoicode=AFT)

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8. If your organization has an events calendar on the web, please provide a URL (example: www.dutchessny.gov/concalendar/calendar.aspx?viewtype=calendar&munipoicode=AFT)

Please provide the URL for your organization (example: www.ThinkDifferently.org)

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9. Please provide the URL for your organization (example: www.ThinkDifferently.org)

Please select (all) the age ranges for individuals you provide access to

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10. Please select (all) the age ranges for individuals you provide access to

Select all services that apply (required)

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11. Select all services that apply (required)

Clinic Services?  If so, select all services that apply (required)

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12. Clinic Services?  If so, select all services that apply (required)

Do you provide Parent Support Groups? If yes, please specify type (i.e. ASD, Downs Syndrome etc.)

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13. Do you provide Parent Support Groups? If yes, please specify type (i.e. ASD, Downs Syndrome etc.)

Do you provide Home Based Services? If yes, please specify type  (i.e. Behavioral Services; Health Services: Supportive Counseling; Crisis Intervention etc).

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14. Do you provide Home Based Services? If yes, please specify type  (i.e. Behavioral Services; Health Services: Supportive Counseling; Crisis Intervention etc).

Population served (required)

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15. Population served (required)

Certification (check all that apply)

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16. Certification (check all that apply)

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