Student Information Form

Name

Name of Student

Phone Number

Address

Does the Student Have an IEP?

Yes No

What school does your child attend? What is the correct spelling of Students name? Parents name? If you are a single parent. Do you have educational Rights?

What School District Does Your Student Attend?

Describe How distance-learning Has Been a Struggle for the Student

ANY OTHER SERVICES YOU WOULD LIKE FOR YOUR CHILD SUCH AS MORE SPEECH AND LANGUAGE, O.T., MORE TIME IN GENERAL EDUCATION CLASSES, SWIMMING, AIDE O THE BUS, 1;1 AIDE, ECT.

Have You Addressed This With the School?

Yes No

Would You Like us to Contact You?

Yes No

What is the Best Time to Contact You?

Parents Name

Does Your student have an IEP

Home Address

Do You Have Educational Rights

Describe How Your Student is Struggling

Have You Addresses This With The School?

Would You Like Us to Contact You?