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First Name
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Last Name
Email
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State
List the grade(s) that your child(ren) are in for this 2023-2024 school year
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Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
8th
9th
10th
11th
12th
College Freshman
2nd Year College Undergraduate
3rd Year College Undergraduate
4th Year College Undergraduate
5th Year College Undergraduate
Graduate Program
Doctoral Program
H.S. Graduate - on a career track
Mark any of the following areas in which your child(ren) have formally been diagnosed with
ADHD
Autism
Twice-Exceptionality (2e)
Gifted
Learning Disabled (in 1 area or more)
Dyslexia
Dysgraphia
Dyscalculia
Executive Function Dysfunction
Oppositional Defiance Disorder
Post Traumatic Stress Disorder
Generalized Anxiety Disorder
Eating Disorder
PANDAS
Sensory Processing Disorder
Tourettes
Do any of your children have an existing IEP or 504?
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IEP
504
Neither
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What type of school do your children attend?
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Public School
Private School
Homeschool
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