Initial Intake- AdvocacyNJ
Thank you for reaching out to AdvocacyNJ. This form is the first step in creating a cohesive advocacy plan for your child. Once this is submitted, our Advocacy Coordinator will reach out to schedule an initial consultation with our Advocate(s) and answer any process-related questions you may have.  
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Child Legal Name *
Child Preferred Name (if different than legal)
Child Pronouns *
Required
Date of Birth *
MM
/
DD
/
YYYY
Current Address *
Current Grade *
School District *
School Name *
Parent/Guardian Name (s) *
Preferred Email *
Preferred Phone number *
What about your child makes you smile? *
How does your child feel about school? *
Has your child always felt this way? *
What struggles is your child facing in the home that may contribute to the school stress? *
Does your child have friends? *
What are your goals for working with an education advocate? *
How did you hear about AdvocacyNJ? *
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