Registration for Services

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete all required items below.
Please allow 48 hours for an SEG representative to contact you and review your registration information.

Email *

Note:

This form is used to gather information about your possible education needs. Consultation sessions are used to discuss the information provided here and to coordinate further steps, if needed. Below, provide details that you would like to discuss during your consultation and any questions you may want answered. Should your situation seem to involve the assistance of another agency (i.e., legal, law enforcement, medical), SEG will inform you, without a consultation.

First and Last Name of Parent/Guardian/Adult: *

Select the nature of your issue or write it next to "Other." *

Advising - questions about school terminology, school options, or school types and processes.

Advising - alternatives for an array of school related topics (i.e., programs, report cards, dietary concerns)

Advising - IEP or 504 plans

Planning - develop student retention (avoidance) plan

Assessment - review of test/assessment results or state report cards

Planning - behaviorial plans, counseling referrals, etc.

Request interaction with district representatives, school admin or staff, or associations

Request interaction with external groups to plan for student success

Other:

Required

Provide a summary of the issue and what you would like to see as an outcome (no worries about spelling). *

Provide a few questions that you have about the situation. *

Provide questions you have about possible ways to fix the issue. *

How did you hear about our services? Select all that apply. *SEG refrains from discriminating against clients and potential employees on the basis of race, ethnicity, color, religion, sex, gender identity, national origin, cognition capacity, disability, age, genetic information, or veteran status.* *

Referred by Sancho Education client

LSN KIDS member referral

General online search

Academic or educational institution

Facebook

Google search

Other:

Required

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms