Give
Careers
Capital Campaign
About Us
Our Team
Our Story
News
Our Services
AIM Post Graduate Program
K-12 School
Lakemary School Referral
Children Services
Psychiatric Residential Treatment Facility (PRTF)
PRTF Admissions
Specialized Services
Case Management
Outpatient Therapy
Adult Services
Residential Living
Day Services
Case Management
Outpatient Therapy
Community Employment
Business Solutions
Transportation
Advocacy
Crisis Stabilization
Ways To Help
Capital Campaign
Ursuline Legacy Park
GIVE
Fund a Need
Volunteer
Events
Fun Run & Walk
Lakemary Golf Classic
Contact
About Us
Our Team
Our Story
News
Our Services
AIM Post Graduate Program
K-12 School
Lakemary School Referral
Children Services
Psychiatric Residential Treatment Facility (PRTF)
PRTF Admissions
Specialized Services
Case Management
Outpatient Therapy
Adult Services
Residential Living
Day Services
Case Management
Outpatient Therapy
Community Employment
Business Solutions
Transportation
Advocacy
Crisis Stabilization
Ways To Help
Capital Campaign
Ursuline Legacy Park
GIVE
Fund a Need
Volunteer
Events
Fun Run & Walk
Lakemary Golf Classic
Contact
Fun Run & Walk
Home
>
Events
>
Fun Run & Walk
Don’t mIss out on the fun! 5k Run/Walk benefiting Lakemary Center!
Sign up to volunteer
Close
PRTF Contact Form
*Please allow 1 week for a response.
Name
Relationship to Child
Email
Phone
Message
Student Information
Age
Sex
IEP Designation
IQ and Academic Level
Does the child have a formal diagnosis of an intellectual or developmental disability?
Please list diagnosis:
Please explain any medical conditions:
Please explain other mental health issues
State Student Resides In
Current Placement
Anticipated Funding Source
Private Pay
School/IDEA funded
Children & Family Services Organization
Dept. of Disabilities/Regional Center
Other
Insurance
Further information
Send
