Questions about BrainSTEPS CO?

Contact:
Janet Tyler, Ph.D.

Phone:
 (303) 866-2879
Email:
 tyler_j@cde.state.co.us

Contact:
Heather Hotchkiss, MSW

Phone:
 (303) 866-6739
Email:
 Hotchkiss_h@cde.state.co.us

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refer A Student to BrainSTEPS CO

Fill out the following form to refer a student to the BrainSTEPS CO program. All referrals to BrainSTEPS CO should only be made after receiving parent approval. Fields with a light-yellow background are required. The information you enter will be submitted to the appropriate BrainSTEPS CO team in the student's geographic area. Once your student referral has been electronically sent to the BrainSTEPS team, please allow several days for the team leader to contact the parent and school.

Student Student:
 (e.g. 01/01/2009)

   
   
Referral Contact Information:
  Primary Parent Contact Information:
 
 
  School Contact (if you have this information):
 
 
 
  Injury Information:




(ex. 01/01/2009)
 
 

 
Has child had a history of any of the following that have been MEDICALLY DIAGNOSED PRIOR to their brain injury occurring?
Therapy

What has this child experienced SINCE his/her brain injury: (does NOT need to be diagnosed)
Therapy

   
   
  BrainSTEPS:

(ex. 01/01/2009)