Inclusive Education Intake Form

  • Terms & Conditions: The National Down Syndrome Society (“NDSS”) is committed to improving education for all individuals with Down syndrome. As established in the Individuals with Disabilities Education Act (“IDEA”), children with disabilities are entitled to have an Individualized Education Plan (“IEP”), and to receive services that enable the student to be involved in, and make progress in, the general education curriculum, while each of the child’s special educational needs are met. To advance this cause, you agree to allow NDSS to collect and store the information you are providing on this intake form (“Intake Information”). This information will be used to (i) assist you in creating an IEP for your child, (ii) provide you with personalized, inclusion education facts and options, and (iii) enable NDSS to work with schools to help them implement inclusion programs (“IEP Use”). In addition to IEP Use, NDSS’ Manager of Inclusive Education Programming, as well as certain other NDSS employees, are mandated reporters of suspected child abuse. In order to carry out their responsibilities, you agree that, when required to do so, NDSS may disclose some or all of the Intake Information, including Personal Information (defined below), to Child Protective Services and, when applicable, other government agencies or officials (“Mandatory Disclosure”). Some of the information we are collecting on the Intake Form about you and your child may be private, sensitive or confidential in nature. Specifically: (i) Child’s Name, (ii) Child’s Date of Birth, (iii) Child’s Address, (iv) Parents’ Names, (v) Primary Phone Number, (vi) Email (collectively, “Personal Information”). NDSS will treat all Personal Information as confidential and, except for Mandatory Disclosures (if required), shall not disclose your Personal Information to any third party, whether an individual, corporation or other entity without your prior written authorization. By accepting these Terms & Conditions, you (i) warrant that you have the right and authority to make the disclosures made on the Intake Form; and (ii) are giving your permission to NDSS to use Intake Information (excluding Personal Information) for an IEP Use, and/or to make Mandatory Disclosures (including Personal Information) to Child Protective Services as required by law. NDSS shall not be liable to you in any manner whatsoever for any IEP Use or Mandatory Disclosure of Intake Information. After we receive your data, a member of the NDSS team will contact you to provide additional guidance and assistance in developing your IEP.