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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. 

Call the NAPSEC office at (202) 408-3338 if you are not sure whether or not your school appears in the 2004-2006 membership directory and/or whether or not we have your profile sheet on file.
* Indicates required fields
* Full name of program:
Street Address:
City/State/Zip:
* Phone:
Fax:
Web Site:
E-mail for program:
* Contact e-mail 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.