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New Service Provider Registration
Questionnaire About You
1. What is your discipline?
2. Do you have a specialty within your discipline? If so, what?
3. What type of degree, certificate, or license do you currently have?
4. What college/university did you attend? 
5. Year of graduation?
6. Tell us about your experience working with clients (i.e. years of experience, age of clientele, specific disabilities and/or programs, etc.)
7. What language(s) do you speak?
8.

Tell us about your philosophy regarding working with families/children.
9. Please add any other relevant information that you want families to know about you.
 

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