Inclusion Support Services School-Age Consultation Request Form

The Inclusion Support Services program works in collaboration with early learning and child care professionals caring for children with special needs, up to age 13, who attend licensed after-school programs. We offer short-term consultation to help educators increase their confidence in building inclusive environments that support all children, through the development of a classroom plan.

This consultation is for school-age programs only, including children aged 4 to 12, who are attending public or privately funded school during the day, and also attend a licensed after-school program. This consultation would take place in the after-school program.

Please submit one referral per classroom.

Request Date

Program Search

Enter at least three characters to search by program name (e.g. Happy Valley) OR street name (e.g. 22 Main). Select your program from the search result.

If you don’t see your program appearing in the search area, clear the characters in the search field and click on the checkbox “My program is not found” to provide your program name and address.

My program is not found

Program Name

Program Address

Supervisor's Name

Classroom

Early Learning and Child Care Professional's Name(s) for this classroom:

Program Phone Number

Program E-mail

Section 1: Resource Consultation Request

General Classroom Consultation is short-term, goal-focused consultation to support early
learning and child care professionals in building their skills related to special needs, inclusion and inclusive practices.

Child-Specific Consultation is short-term, goal-focused consultation that supports the early identification of developmental, social, emotional or behavioural needs that may be impacting a child’s participation in a child care program. Parental consent is required for consultation to take place.

Please select one method of consultation you wish to receive from Inclusion Support Services

General Classroom Consultation

Child-Specific Consultation

Section 2: Preparation for School-Age Resource Consultation

Please complete the questions below before submitting this form. An Inclusion Support Services early interventionist will review these responses with you during your initial consultation.

What do you hope to accomplish for this consultation?

What concerns led you to request this consultation?

What is the issue, challenge or concern you would like support with?

What have you tried?

Before you submit - If you would like a copy of this form for your records please right click and select print.