First Name
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Email
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Child First Name
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Child Age
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When Did Your Child First Receive An IEP?
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Pre-K
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Senior
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What Is Your Child Primary Diagnosis?
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Intellectual Disability
Hearing Impairment
Speech/ Language Impairment
Visual Impairment
Orthopedic Impairment
Autism
Traumatic Brain Injury
Other Health Impairment
Specific Learning Disability
Developmental Delay
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What Are Your Child Academic Goals?
What Are Your Concerns With Your Child's Current IEP?
Was There An Additional Assessment Requested But Denied?
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Yes
No
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Are Your Child Academic Needs Being Met? Explain
Does Your Child Have Any Behaviors In School?
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Yes
No
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If There Are Behaviors, Please Explain
Is Your Child Making Good Academic Progress? Please Explain
What Support Strategies Do You Use That Work?
Explain What Engages Your Child, And What Disengages Them.
What Are You Looking To Get Out Of This Process?
Confident In Understanding IEP And Process?
Please Select One
Yes
No
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What Areas Of The IEP Process Are You Struggling With The Most?
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