Does the school provide technology for student use?
Clear selection
Student is currently receiving the following services (check all that apply):
Social Worker contact info *
Your answer
School attending after high school
Your answer
Area of study post high school, if known
Your answer
Caregiver name and relationship to child *
Your answer
Caregiver contact info: phone and/or email *
Your answer
Caregiver mailing address (so we can send check)
Your answer
Describe your request and amount needed. *
Your answer
List other sources of funding that may be used for this item: examples may include:TANF child only grant, Treehouse funds, OT/PT/ speech services, fafsa, Passport, ETV, monthly reimbursement.