DuguayEd Consulting and Advocacy Intake Form
Thank you for reaching out and we are excited to meet with you! To schedule your non-refundable $150 30-minute consultation and learn more about what we can do to support you and your child, please fill out this form. We will reach out to schedule a zoom or phone call based intake appointment. The more details you can provide, the more effective your consultation will be. If you have any questions about the form, please email Meryl Duguay at Meryl@DuguayEd.com, and Aspen@DuguayEd.com 
כדי לשמור את הטיוטה אפשר להיכנס לחשבון Google. מידע נוסף
Email *
Today's Date *
MM
/
DD
/
YYYY
Your first and last name *
Your child's first name *
Your email address *
The best phone number to reach you
Do you and your family currently reside in Colorado?  *
What school does your child attend?
Does your child currently have an IEP? If so, what disability did they qualify under? 
Please indicate any of the follow plans your child might have: 
Does your child have any medical diagnosis? If so, can you share them? (You are not obligated to disclose this information, but it can be helpful)
Please indicate the area or areas of need for your child *
חובה
Is the school aware of your concerns for your child? If so, have you requested an evaluation or an IEP meeting? 
Has the school completed a comprehensive educational evaluation for your child?  *
Please list any educational services, placements, aides, accommodations/modifications, and evaluations that you have requested and have been denied by the school. 
If the school denied anything above, did the write a prior written notice explaining why? 
ניקוי הבחירה
What support would you want from an educational advocate? Select all that apply. *
חובה
Why are you seeking advocacy support today? Please share as many details as possible.  *
שליחה
ניקוי הטופס
אין לשלוח סיסמאות באמצעות Google Forms.
הטופס הזה נוצר בתוך duguayed.com. דיווח על שימוש לרעה
Google Forms