First Name

Last Name

Email Address

Phone Number

Home city and state

Child's Name

Child's Age

Child's Grade

Are you their legal guardian? Are you their legal guardian? Yes No

Is their case involved in due process, mediation, and/or a settlement agreement? Is their case involved in due process, mediation, and/or a settlement agreement? Yes No

Name of the School and District

Do they currently have an IEP? Do they currently have an IEP? Yes No

If yes, when was their last IEP meeting?

If Yes, when was their last IEP assessment?

Do they currently have a 504 plan? Do they currently have a 504 plan? Yes No

If yes, when was their last 504 plan meeting?

Are you currently working with Special Education Advocate or Attorney? Are you currently working with Special Education Advocate or Attorney? Yes No

What would you like from the school? What would you like from the school? Test my child Hold an IEP Get better/new supports Conduct better assesments Start the IEP process Other

Where do you need support? (select one or more) Where do you need support? (select one or more) Get my child their first IEP Communicate better with my school Make sense of reports or get better ones Get better IEP or 504 meetings Other

I understand Lisa Mehlbrech is a non-attorney special education advocate and DOES NOT PROVIDE legal advice. I understand Lisa Mehlbrech is a non-attorney special education advocate and DOES NOT PROVIDE legal advice. I Agree

I understand this questionnaire is for informational purposes only, and all educational decisions are my own. I understand this questionnaire is for informational purposes only, and all educational decisions are my own. I Agree

Where did you hear about Kids 1st Advocacy?

Is there anything else you'd like us to know?