Letter Of Intent Template Disability Minor And Legal Matters (Page 3 of 7) in pdf

Letter Of Intent Template Disability Minor And Legal Matters Page 3

Resource Coordinator, Agency

Name, address and phone number:

Respite Providers

Name, address and phone number:

Current Lifestyle and Expected Changes

Typical daily routine (include weekdays and weekends)

Activities/Interests:

Does he/she attend a church? Religious Affiliation?

Anticipated changes in the next two years:

What activity does your child particularly like or dislike? Consider recreation, sports and

fitness activities. Think also about other likes and dislikes (food, hobbies etc.).

Favorite places to visit in the community where people are familiar:

Who are your child’s friends and their parents (include contact information)?

How does your child react during stressful times? Are there certain things that someone

should know about helping your child through particularly stressful times or transitions in

your child’s life? Is there a particular person who can provide comfort in an emergency

(clergy, friend)?

Special supports and services currently receiving:

Who provides them, how are they paid?

Have you applied for special supports and programs including public benefits?

Are you currently on a waiting list for any service? Include the name of the service,

contact person, phone number, date and status of application.

Letter Of Intent Template Disability Minor And Legal Matters Page 3