A. General Information Your Name: Address: City: Phone: Email Address: 1. Do you have a family member with special needs? (Select Response)YesNo If yes please answer the remaining questions with your family member in mind.   2a. Name of individual with special need: 2b. Age: 2c. Grade (if applicable): 2d. Relationship to you: 2e. Description of special need:   B. Education (Sunday School Vacation Bible School Bible Study Special Programs) 3. How can we better facilitate communication between parents and teachers so that teachers can know what to expect and how to handle the special needs of an individual in their class or group? 4. What kind of supports (e.g. similar to those in a student's IEP) would be helpful? Assistant in the classroom 1:1 instruction Special break-out classes Modification of materials and curriculum Professional training for teachers Picture schedule Seating (e.g. cube chair) Other (please describe): 5. How can we address the needs of teens with special needs? Peer mentor Adult mentor Other (please describe):   C. Worship 6. How can we make worship more accommodating to those with special needs? Set aside a service on a regular basis that is dedicated to families with special needs (similar to the Children's Museum's "First Thursdays") Provide Sign Interpreter Provide large print or Braille materials Other (please describe):   D. Family Support 7. How can Grace support families and caregivers of those with special needs? Establish support group(s) Provide child or respite care Provide library resources Sponsor Presentations/Other (please describe):   E. Reaching Outside of Grace 8. If you are aware of special needs individuals in need of a church home please describe and/or provide contact information: 9. If transportation is an issue please describe what is needed: 10. How can we communicate that Grace welcomes everyone? 11. If you are aware of other organizations with which Grace might partner to meet the needs of special populations please describe:   F. Other 12. What physical or structural changes at Grace would be helpful to those with special needs? 13. Other comments: 14. If you would like to participate in our efforts to help those with special needs select "Yes" (Select a response)Yes please contact me.Not at this time Do not enter anything in this field: