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First Name
Middle Name
Last Name
Previous Name(s)
Preferred Name
Date of Birth
Residential Address
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Email
Phone
Gender
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Agender/Genderless
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Bigender
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Demi-boy
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Demi-girl
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Prefer Not to Answer
Race
Ethnicity
Caucasian
Latino/Hipanic
Middle Eastern
African
Caribbean
South Asian
East Asian
Mixed
Primary Language
Secondary Language
Interpreter Needed
Yes
No
School Attending or Last School Attended
Grade
District
School Address
School Phone
Expected Graduation Date or Year Graduated
Diagnosis of Developmental Disability
Physician Name
Phone
Address
City, State, Zip
Psychologist/Psychiatrist Name
Phone
Address
City, State, Zip
Other Doctors/Hospitals Name
Phone
Address
City, State, Zip
Other Doctors/Hospitals/Specialists that may have records of diagnosis and/or treatment
Parent/Guardian First Name
Last Name
Phone
Email
Address
City, State, Zip
Role
Mother
Father
Legal Guardian
Child Protective Services (CPS) Involvement?
Yes
No
Additional Information
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Useful Links
Services
Early Intervention
Transition
Adulthood
Services and Support Administration (SSA)
Special Olympics
Transportation
Investigative Services Department
Self Advocacy
Fairhaven School
Fairhaven Preschool
School Age
Fairhaven School Calendar
Therapy
Fairhaven Nursing Clinic
Transition
Special Olympics
Cafeteria
Providers
Training and Events
Nominate for DSP Award
DSP Appreciation
Resources
Resources
Communication Boards
Abilities Unite
About Us
Leadership
Board Members
Calendar of Events
What's New
Publications
Policies
Bill of Rights
Careers
Spirit Gear
Contact info
330.652.9800
mymail@mailservice.com
45 North Road
Niles, Ohio 44446
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Contact Info
330.652.9800
info@tcbdd.com
45 North Road
Niles, Ohio 44446
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