top of page
White Sheet
Abstract Waves

SPED SUPPORT CLIENT INTAKE FORM

hello, I am happy you're here.

Please answer the following questions to the best of your ability. ALL INFORMATION WILL REMAIN CONFIDENTIAL, and will ONLY be seen and used by Mrs. Thomas, your Family Advocate.

Does the student currently have a 504 Plan or IEP?
Nature of the Student's Disability (check all that apply) Required
Do you prefer to meet in person or online using Zoom (or a similar platform)?
Do you agree to communicate via text as needed?
What is your preferred method of payment?

Thank you for submitting this information!

bottom of page