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Client Intake Form
First name
Last name
Email
Phone
Address
Your Child's Full Name (First, Last)
Birthday
Month
Day
Year
Child's Current School & District
Grade
Does your child currently have:
IEP
504 Plan
SST Plan
None but seeking supports
Is there an IEP / 504 / SST meeting coming up that you want advocate support for?
Month
Day
Year
What if any medical diagnoses does your child have?
If divorced, what legal custody do you have?
Sole legal custody
Tie breaking or Ed Rights
Joint legal
I do not have legal custody of my child
Upload your custody order
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What are the main issues you are seeking advocacy support for?
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