South Florida Charter School Intake
Chaplin Learning Solutions, LLC
Thank you for your interest in partnering with Chaplin Learning Solutions, LLC. This form helps us better understand your school's current student support needs, compliance structures, and areas where additional consultation or services may be beneficial.
School Information:
School Name:
*
School Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School Type:
*
Charter
Private
Public
Religious/Parochial
Other
County/District:
School Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grades Served (Check all that apply):
*
Pre-Kindergarten
K-5
6-8
9-12
Total Student Enrollment:
*
Primary Contacts
Principal Name:
*
First Name
Last Name
Principal Email:
example@example.com
Assistant Principal Name:
*
First Name
Last Name
Assistant Principal Email:
example@example.com
Student Support Data
Current Student Counts
504 Plans:
Gifted EPs:
IEPs:
English Language Learners (ELL):
Behavior Intervention Plans (BIPs):
Students receiving MTSS/RTI interventions:
IEP Service Delivery Breakdown
Number of students receiving:
Consultation Services:
Support Facilitation / Inclusion / Collaboration:
Resource Pull-Out Services:
Self-Contained Services:
Speech/Language Services:
Occupational Therapy:
Physical Therapy:
Behavioral Services:
Compliance & Operations
Current Staffing
Does your school currently employ:
ESE Specialist(s)
504 Coordinator
School Psychologist
Staffing Specialist/Compliance Support
Behavior Specialist
If yes, please describe staffing structure:
Current Needs / Areas of Concern (Check all that apply):
IEP Development & Writing
Eligibility Meetings
Annual Reviews
Re-Evaluations
504 Compliance
Gifted Compliance
Inclusion Support
Staffing/Case Management
Compliance Audits
FTE Documentation
Parent Communication Support
Manifestation Determinations
Behavior Support/FBAs/BIPs
Teacher Training/Professional Development
Executive Functioning Support
Classroom Accommodations
Transition Planning
State Monitoring Preparation
MTSS/RTI Support
Due Process/Complaint Support
Program Development
Scheduling/Service Delivery Support
Staffing Shortages
Other
Professional Development Needs
Please indicate any staff training areas of interest:
Writing Compliant IEPs
Accommodations & Modifications
Inclusive Practices
Behavior/Classroom Management
Executive Functioning Strategies
Autism Support Strategies
Dyslexia & Reading Interventions
Trauma-Informed Practices
MTSS/RTI
504 Compliance
Progress Monitoring/Data Collection
Differentiated Instruction
Transition Planning
Legal Compliance in ESE
Other
Additional Information
Please share any additional information about your school's needs, goals, or current challenges:
Preferred Next Steps
Initial Consultation Call
On-Site Meeting
Virtual Meeting
Proposal/Quote Request
Compliance Review
Staff Training Information
Preferred Contact Method:
Please Select
Email
Phone
Virtual Meeting
Best Time to Contact
AM
PM
Submit
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