"KIT Inclusion Support Center Call Request Form: After you fill out this form you can schedule your call. You will need to submit a new request for each individual child, classroom, or program you wish to discuss. If you have any trouble, please contact us at SupportCenter@kit.org, or 8448712966"

START HERE

Are you requesting a call for a child in a military program or a community-based program?

Provider Information

Provider first name

Provider last name

Provider role

Site Director email

If applicable, enter an email address where the Site Director can receive calendar invites for the scheduled call

Site Directors: Enter your Area Manager's email address:

Email address

Work email addresses only; no personal email addresses.

AlphaBEST manager

Preferred phone number for this call

We are unable to call DSN numbers

Organization

If your site is not shown below, please contact supportcenter@kit.org for assistance with scheduling your call.

Girl Scouts site

If your district is not an option in the list below, please select "*New district" and then enter its name in the New district name field.

District

New district name

If your school/site is not an option in the list below, please select "New School" and then enter its name in the New school name field.

School/site name

New school name

Program Information

Military branch

Organization name

If your location is not an option in the above list, please contact us at supportcenter@kit.org.

Air Force Acronyms

AFB = Air Force Base
RAF = Royal Air Force
SFB = Space Force Base

Army Acronyms

AFRC = Armed Forces Recreation Center

USAG = United States Army Garrison

Coast Guard Acronyms

USCG = United States Coast Guard

CSC = Community Services Command

Marine Corps Acronyms

MCAGCC = Marine Corps Air Ground Combat Center

MCAS = Marine Corps Air Station

MCB = Marine Corps Base

MCCS = Marine Corps Community Services

MCLB = Marine Corps Logistics Base

MWTC = Mountain Weather Training Center

USMC = United States Marine Corps

Navy Acronyms

JEB = Joint Expeditionary Base

NAF = Naval Air Facility

NAS = Naval Air Station

NASJRB = Naval Air Station Joint Reserve Base

NAWS = Naval Air Weapons Station

NB = Naval Base

NCBC = Naval Construction Battalion Center

NMC = Naval Medical Center

NS = Naval Station

NSB = Naval Submarine Base

NSA = Naval Support Activity

NSF = Naval Support Facility

NWS = Naval Weapons Station

Type of program

Center name (if applicable)

Classroom (if applicable)

Call Details

Are you a participant in the Elevated Support Model pilot?

If you don't know what this is, select "No"

Is this call request related to a previous call with KIT?

KIT offers calls related to:
One specific child in your program - you will collaborate on strategies to support that individual child,

OR

A classroom or program - to discuss multiple children (5 or more) that are in the same classroom, or there are program-level questions or needs.

Are you requesting support for a specific child or a classroom/program?

Call Tier

Using the graph below, determine the appropriate tier level for this call. Note that Tier 1 calls do not need an ISC call.

Graphic of pyramid showing three different tiers with descriptions for each level

Call Tier

Child Info

Child's first name

Child's last initial

Ex: If the child's last name is Gomez, enter G

Child's gender

Age of child

Child's birth month

Child's birth year

(ex. 2017)

Any identified diagnosis?* (select all that apply by holding down the Shift key)
*Only select known diagnoses, not suspected. Select "No diagnosis" if the child has not been diagnosed. Select "Evaluation/assessment in progress" if the child is currently being evaluated for a potential diagnosis.

If other, please describe

Is there any inclusion or behavior plan in place? (e.g., BSP, ISP, IEP, etc.)

Please indicate which plans below (select all that apply).

Does the child have an accommodations plan?

Will the child's parent/guardian be attending the call?

If a parent/guardian is joining the call, please explain that the focus of KIT’s recommendations is on supporting the child in the group care setting. We are not clinicians and cannot make recommendations for using a specific therapeutic intervention. We welcome the family perspective and believe they are valuable team members.

Do concerns include sexual behavior?

Please list the child's/classroom's strengths

Provide a brief explanation of the reason for your call.

What is your level of concern regarding the child/situation you want to discuss?

NoneLowMediumHigh

To what degree do you believe that you can improve this situation?

NoneLowMediumHigh

Additional notes (anything else you want to share or we should know?)

Alternate Point of Contact (POC)

If known, please add a backup staff member we could talk with if you are unavailable at the time of the scheduled call.

Staff First Name

Staff Last Name

Staff Email Address

Staff Role

Clicking "Submit" will direct you to our scheduling site to book your appointment. The page may take a minute to load, but please reach out if you have any trouble.

Additional Staff on Call

Please only include staff members (up to 3) who have a military email address

Staff 2 First Name

Staff 2 Last Name

Staff 2 Email Address

Staff 2 Role

Staff 3 First Name

Staff 3 Last Name

Staff 3 Email Address

Staff 3 Role