Name of School:

Street Address:

City:

State:

Phone:

- -

Fax:

- -

Approximate # of children in need of services:

Approximate # of IEPs to be addressed immediately:

Approximate # of required therapists:

Approximate Project Starting Date:

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2012 2013