School 
Personnel 
and 
Information 


Name 
of 
School_________________________________________________________________ 
Address_______________________________________________________________________ 
Phone____________________________________ 
Fax_________________________________ 
Principal_______________________________________________ 
Counselor______________________________________________ 
Teacher________________________________________________ 
Teacher 
Aide____________________________________________ 
Resource 
Teacher________________________________________ 
Psychologist____________________________________________ 
Speech 
Therapist_________________________________________ 
#_____________________ 
Occupational 
Therapist____________________________________ 
#_____________________ 
Physical 
Therapist________________________________________ 
#______________________ 
Bus 
Compound 
Phone__________________________________Bus 
#_____________________ 
Bus 
Driver’s 
Name________________________________________ 
#_____________________ 
Bus 
Assistant 
Name_______________________________________ 
Head 
of 
Transportation____________________________________ 
Placement 
Coordinator____________________________________ 
Parents 
of 
Classmates: 
________________________________________________________ 
#____________________ 
________________________________________________________ 
#____________________ 
________________________________________________________ 
#____________________ 


The 
Council 
on 
Developmental 
Disabilities 
Family 
Outreach 
& 
Support 


502.584-1239