Special Education Support Request Form

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We are here to support you. Please fill out the following questions and you will be contacted by one of our consultants.

Email *

First and Last Name *

District *

School *

Contact Information: *

I am needing assistance in the following area: *

Please give a brief description of your need and/or request. *

I understand that the Region 16 ESC does not provide child-specific evaluations and/or recommendations. *

I understand that an on-site request of the Region 16 ESC staff is to support adults as they serve children. Region 16’s role is not to evaluate, assess, or work directly with students.” *

A copy of your responses will be emailed to the address you provided.

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