Intake Information

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Intake Information

Thank you for your interest in Advocating 4 Kids Inc expert advocacy services.
Please answer all the question. This information will help identify the best approach, packages and assist with us discussion outcomes and resolution

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Adres e-mail *

Parents Name *

What City and state does your child attend school *

Phone number *

Students Name *

Please select which disability your child has or you suspect him/her of having. Check as many that apply *

ADHD ( other health impaired)

Autism Spectrum Disorder (ASD)

Down Syndrome.

Hearing Disorders

Intellectual Disabilities

Learning Disabilities ( Dyslexia Dysgraphia Dyscalculia)

Non-verbal

Non-Mobile

Seizure Disorders

Tourette Syndrome

Traumatic Brain Injury.

Visual Impaired

Mental Health disorder

Behavioral/Emotional

Speech and Language delays

Development Delays

Inne:

Is your child currently receiving special education services? *

Yes

Is your child currently getting services under a Section 504 ? *

Yes

Which statement below best describes your current issues: *

The School is not implementing IEP or 504 correctly

Your child continues to have trouble with academics even with the IEP or 504 plan

You requested evaluations for your child and the school said no

You suspect someone has been aggressive towards your child ( student comes home with marks, or bruises)

Your child continues to get suspended and/or behavioral referral even with the 504 or IEP?

Your child has been suspended or expelled from school

Your child has a 504 plan and you think your child needs an IEP

You are looking for guidance's about your child's special education services.

You want someone to review your child's IEP and provide feedback on its appropriateness

You a need a Coach to help you teach about your rights under special education

Inne:

What happened to make you want to hire an Special Education Advocate. (i.e., my child was suspended at school; I don't trust the school; my child can't read) *

What steps have you taking to get your concerns resolved by the IEP team members, and/ leadership at your child's school?
What was the outcome of those efforts? *

List the outcomes you want advocating 4 kids to advocate for? (ex. I want additional evaluations.) *

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