F.A.C.T. Support Groups Orange County


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Orange County Services

FACT is looking to expand its services to support Orange County families. We would appreciate your input regarding the development of these services.

Please fill out this form completely. Items in bold are required.

Parent's First Name

Parent's Last Name

Street Address

Apartment / Suite

City

State / Zip (5 digits min.)
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Telephone
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Cell Phone
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Other Phone
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Email

Best Time/Way to Contact You

Target Child's Name / Age

Diagnosis

Siblings Name(s) / Age(s)

Do you receive services from Regional Center?

Please let us know what services would be helpful to you and your family. Check all boxes that apply:

Help for our child at home more info

Meeting other families (Support Groups) more info

Where would you suggest that we locate these groups?

Help for our child at school more info

From which school district or SELPA do you receive services?

Summer camp more info

Family outings more info

Relationship Development Intervention (RDI) more info

Please let know anything else you think would help us to develop services that would support families in the Orange County area. Please note that we are a not for profit family based agency and would hope to make our services available to all families that could benefit.