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NAPSEC Member Profile Update

Please include any information that needs to be added or changed on your program profile in the fields below.  You may leave fields blank if they do not require changes. Your previous information will be inserted into the blank fields. For members that have not yet filled out their profile sheet, please complete this entire form. 

* Indicates required fields
* Full name of program
Street Address
City/State/Zip
* Phone
Fax
Web Site
Email for program
* Contact email for NAPSEC
Director/President/
Principal of program
NAPSEC contact name
Year founded
Date your program joined NAPSEC
Types of disabilities served
(Please do not use abbreviations)
Program description

PROGRAM PROFILE
Enrollment
(check all that apply) 		Male    Female    Coed
Age range served
Age at admission
I.Q. range served
Program:
(check all that apply) 		Day    Residential    Summer
Staff to client ratio
Program length
(in days)
Current enrollment
Total capacity
Admission procedures
Accreditation (NCASES, COA, JCAHO, etc)
Funding approval (State and/or agency name)

Additional comments

or clarifications

Thank you.