(DTT) After School Program Our After School Program is designed to provide training after school and during school breaks; during these periods we provide specialized sensory-motor, cognitive, communicative and social interactions, and behavioral training. Consumer InformationPlease list all the persons you are requesting services for, along with ages and diagnosis.*NameAgeDiagnosis Do any of the listed consumers have a second diagnosis?–YesNoIf there is a secondary for any of the above consumer's please list them here:*NameDiagnosis Requestor InformationRequestor's Name* First Last Requestor’s Email* Requestor’s Phone*Support Coordinator* First Last Support Coordinator's Phone*Desired Consumer Start Date* MM slash DD slash YYYY When is the best time to call? : Hours Minutes AM PM AM/PM Do you need transportation? Yes No PhoneThis field is for validation purposes and should be left unchanged. Δ