Guardian’s Name *

Relationship to Student *

Email *

Phone *

First Name *

Last Name *

Date of birth

Select all diagnosed disabilities *

ADHD/Executive Function disorder

Autism

Specific Learning disabilities ( Dyslexia/Dysgraphia/Dyscalculia/ Auditory processing disorder/ Language processing disorder/ Nonverbal learning disabilities

Emotional Disabilities ( Opposition Defiant Disorder/Conduct Disorder)

Speech and Language

NA

Gender

Male

Female

Identify *OTHER Disabilities

School District *

School Name *

Students Grade *

Does the student have a *

IEP

504 Plan

Neither yet

Requested Services (Select all that apply) *

Virtual Attendance at IEP/504 Meetings

Student Progress Monitoring

Email Monitoring & Communication Support

Technical Assistance

Dispute Resolution Services

Case Documentation & Record Keeping

Direct Advocacy Support (for 2-3 IEP Meetings)

IEP/504 Record Review

Progress Monitoring

Schedule Your Personalized Consultation

Once you complete this step, you’ll be able to schedule your consultation.

Before selecting your appointment time, we ask that you complete this brief form. This is your space to share what’s most important about your child’s educational journey—the questions, concerns, and context that will help us show up prepared to support you with clarity and care.

The information you provide is confidential and used solely to guide our conversation.

Become a Member of the Advocating 4 Kids Elite Community Today!

contact us

Email address: [email protected]

Business phone number: +1 757-751-0981