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Early Connections is a referral service linking callers to resources. North Carolinians needing resources can access a database of service providers and members of families with children who have special needs who are willing to be a resource regarding topics of early intervention and early childhood. Access Early Connections resources by calling Family Support Network of North Carolina at (800) 852-0042.

Screening of the resources referred and negotiation of payment for services are the responsibility of the caller requesting services.

For more information please contact Laura Curtis, Education & Outreach Coordinator, (800) 852-0042 or (919) 966-0334 or laura_curtis@unc.edu.


* - denotes required fields

Permission
Does the Family Support Network of North Carolina have permission to maintain and release the information below as part of a database of educational assistance resources for NC's families and service providers?
   Yes, continue with the rest of the form.
   No, stop here

*Contact Info
Name First   
Last
Associated Agency
Addresses
Work Line 1 (Organization Name)
Line 2
Line 3
   City
 County
 State Zip
Home Line 1
Line 2
Line 3
   City
 County
 State Zip
Phone Numbers
Type
Number
(xxx) xxx-xxxx
Ext.
Work
Home
Fax
Cell



Email
      Work
Personal
Web Site
*Type of Resource
Presenter Mentor
 Family Resource
Person with special needs
Parent of a child with special needs
Other family member of a child with special needs
Consultant/Panelist
Current Profession
Audiologist Early Intervention Service Coordinator Occupational Therapist (OT)
Auditory-Verbal Therapist (AVT) Early Interventionist (EI) Parent Educator
Certified Occupational Therapy Assistant (COTA) Family Service Coordinator Physical Therapist (PT)
Child Care Center Director FSN Local Program Coordinator Physician
Child Care Consultant Full-time Parent Physician Assistant
Developmental Day Director Genetic Counselor Professor
Early Childhood Educator Inclusion Specialist Program Director
Early Childhood Special Educator Literacy Instructor Psychologist/Mental Health Professional
Early Intervention Consultant Nurse (RN/LPN) Social Worker
Early Intervention Director Nutritionist Speech Language Pathologist (SLP)
Other:
Current Work Setting
Child Care Center Hospital Preschool
Children's Developmental Services Agency (CDSA) Neonatal Intensive Care Unit (NICU) Private Practice
Developmental Day Care Outpatient Rehabilitation Clinic School
Home-Based Services Pediatric Intensive Care Unit (PICU)  
Other:
*Education
High School Diploma
Associates Degree (AA/AS)
Bachelors Degree (BA/BS)
Masters (MA/MS)
Doctorate (PhD)
Doctor of Medicine (MD)
Other:
Certification & License
Birth to Kindergarten (B-K) Certificate Occupational Therapy License
Infant/Toddler/Family Administrator Certificate Physical Therapy License
Infant/Toddler/Family Associate Certificate Speech Language Pathology License
Infant/Toddler/Family Specialist Certificate Teaching License
Licensed Clinical Social Worker (LCSW)  
Other:
Language
American Sign Language
French
Spanish
Other:
Age Group Currently Serving
Infant-Toddler Program
Preschool Program
Ages 5 - 21
Adults
*Age Group of Expertise
Prenatal
Birth to 3 Yrs
Preschool (3-4 Yrs)
School Age (5-8 Yrs)
School Age (9 - 21 Yrs)
Adult (Over 21 Yrs)
Any Age

*Areas of Expertise
Please put a check by the topics that describe your areas of knowledge where you are willing to serve as a resource. Please add any specific knowledge you have if it is not listed. This information will be used to make referrals to callers.

Special Needs Assessment & Intervention
ADD/ADHD
Alcohol/Drug Exposure
Atypical Development/Developmental Delay
Autism Spectrum
Cerebral Palsy
Communication Disorders
Developmental Disabilities
Down Syndrome
Genetic Conditions
Health Impairments
Hearing Impairments
Learning Disabilities
Learning Styles
Mental Illness
Physical Disabilities
Prematurity
Self-esteem
Special Needs (General)
Spina Bifida
Traumatic Brain Injury (TBI)
Typical Child Development
Visual Impairments
Other:
Adapting Activities
Assessment (General)
Assistive Technology
Cognitive Development
Consultation Model
Developmentally Appropriate Practices
Early Literacy
Feeding
Health/Nutrition and Safety
Hearing & Vision Screening
Inclusion
Language Development
Motor Development
Natural Environments
Neuro-Development Treatment (NDT)
Play-based Assessments
Positive Behavioral Support
Preschool Readiness
Preterm Baby Screening
Program Assessment
Sensory Integration
Teaching Strategies
Transdisciplinary Model
Other:
Family Community & Professionalism
Communication and Collaboration
Family Support
Family-centered Care
Grief and Loss
Home Visiting
Individual Education Plan (IEP)
Individual Family Service Plan (IFSP)
Parent Involvement
Parent-Child Relationship
Parenting Skills
Transition from NICU to Home
Transition from Part C to Part B
Transition from Preschool to Kindergarten
Other:
Advocating for Children
Americans with Disabilities Act (ADA)
Appropriate Use of Interpreters
Community Resources
Conflict Resolution
Cultural Diversity
Exceptional Children's Program
IDEA and Related Legislation
Interagency Collaboration
Local and/or Regional Interagency Coordinating Council (LICC/RICC)
NC Child Care System
NC Infant-Toddler Program
Parent Leadership in Community
Professional Ethics
Program Administration
Stress Management
Team Building
Other:

*Locations

What counties would you be willing to serve?

All of North Carolina
Alamance Cumberland Johnston Randolph
Alexander Currituck Jones Richmond
Alleghany Dare Lee Robeson
Anson Davidson Lenoir Rockingham
Ashe Davie Lincoln Rowan
Avery Duplin Macon Rutherford
Beaufort Durham Madison Sampson
Bertie Edgecombe Martin Scotland
Bladen Forsyth McDowell Stanly
Brunswick Franklin Mecklenburg Stokes
Buncombe Gaston Mitchell Surry
Burke Gates Montgomery Swain
Cabarrus Graham Moore Transylvania
Caldwell Granville Nash Tyrrell
Camden Greene New Hanover Union
Carteret Guilford Northampton Vance
Caswell Halifax Onslow Wake
Catawba Harnett Orange Warren
Chatham Haywood Pamlico Washington
Cherokee Henderson Pasquotank Watauga
Chowan Hertford Pender Wayne
Clay Hoke Perquimans Wilkes
Cleveland Hyde Person Wilson
Columbus Iredell Pitt Yadkin
Craven Jackson Polk Yancey
*Summary
Please share with us a brief summary of yourself (background, special interests, work settings, etc.) so that we may be able to share this with callers or mentees.