Using the list below, please write the disability or special need in the appropriate location (if other, please specify)
Intellectual/Developmental Disability: Intellectual Disability, Autism
Physical/Orthopedic/Mobility Impairment: Multiple Sclerosis, Muscular Dystrophy, Cerebral Palsy
Sensory/Communication Impairment: Blind/vision impaired, Deaf/hard of hearing
Mental/Emotional/Psychosocial Impairment: Mental Illness, Mood/Personality Disorders
Degenerative Neurological Impairment: Dementia/Alzheimer’s, Parkinson’s, ALS
Neurological Impairment (nondegenerative): Stroke, Traumatic Brain Injury, Spinal Cord Injury
Medically Fragile/Frail Elderly
Other (please specify below)