Fw: After School Program Needs Assessment

[Guest guest]

For those of you in DuPage, here is the attached After School Program Needs

Assessment:

3100 South Central Avenue • Cicero, Illinois 60804

708.863.3803 phone • 708.863.3863 fax • 708.863.7653 tty

www.seguin.org

DuPage County After-School

Program Needs Assessment

Seguin Services Inc, a not-for-profit agency serving adults & children with

developmental disabilities, seeks your feedback.

Please complete the following survey as it pertains to after school services for

youth living in DuPage County.

Assuming that a school aged member of your family or household requires support,

supervision or other service/s after the

school day ends OR that you are a decision maker or professional working closely

with a person who has the above needs:

What types of after-school supports/activities are of interest?

o Cooking o Recreation o Tutoring (Subject Specific)

o Fitness o Fine Arts o Socialization o Volunteerism

What is/are the age/s of the person/s needing supports?

Town / City / Village of residence

Last school attended or current placement

What special needs are present?

o Autism Specific o Personal Care o Behavioral Intervention o Mobility

Limitations

o Other o Other

How many days per week would be most beneficial? What is an affordable rate per

hour?

Does the person needing support have any funding source? o Yes o No

If “Yesâ€, please indicate type (i.e. AHBS, SSI etc):

What operational hours would be most beneficial? to

Is care during breaks (holiday / summer) necessary? o Yes o No

What mode/s of transportation does the person needing support currently utilize?

Would a non-developmentally disabled sibling also take part in the program? oYes

oNo

Would you be willing to take part in a focus group? o Yes o No

If you would like more information or have questions pertaining to after-school

services in the DuPage County region please

supply contact information:

Name: Address:

Phone: E mail:

Please indicate preferred method of contact

If by phone, please circle preferred hours: 8am-12pm 12pm-4pm 4pm-8pm

Preferred Language: o English o Spanish o Other (please specify):

Seguin is committed to integrate, enrich and empower people with disabilities

and

other special needs, so they can be productive, valued members of society.

Ellen Garber Bronfeld

egskb@...

Transition Planning Committee Members,

As I mentioned at yesterday’s DuPage County TPC, Seguin Services is seeking

feedback on the need for an after school program in DuPage county.

If you are aware of a family in need if support for their child / children after

the traditional school day ends, please pass this survey along.

The attached form can be filled out electronically and returned via email to me

at cburke@....

If for any reason an interested party completes the form manually, I would be

glad to stop by any of your sites and retrieve them.

We ask that the survey be completed by Friday, November 11th.

Casey B Burke

Day Services Department Administrator

Seguin Services Inc

phone: 708-222-2288

fax: 708-482-0021

cburke@...