Your Name *
Your Name
Student's Name *
Student's Name
Student's DOB *
Student's DOB
e.g. Parent, Guardian, etc.
Guardian Appointment Date
Guardian Appointment Date
If Guardian, date of court order appointing you as such.
If parents are not currently married to each other, please describe the student's legal custody arrangements and which parent the student lives with most of the time. Also describe who primarily deals with school issues such as homework, preparing for tests, and communicating with teachers.
Student's Address *
Student's Address
Your Address
Your Address
If different than students.
Is Student's Current School the Neighborhood School? *
The school that siblings attend?
Your Home Phone *
Your Home Phone
Your Cell Phone *
Your Cell Phone
Your Work Phone
Your Work Phone
Does the Student have Down Syndrome? *
Are you a member of Down Syndrome Association of Central Texas? *
Have you ever had an advocate or an attorney handling any aspect of the student's special education or who has contacted the school/school district on your behalf? *
Have you ever filed a complaint with TEA or other state or federal agency about the student's educational issues, sought mediation with the school district, or asked for a Due Process hearing over an issue with the school disctrict? *
When is the student's next scheduled IEP meeting (ARD)? *
When is the student's next scheduled IEP meeting (ARD)?
What supports, services and modifications does the student currently receive? *
Please select all that apply.
Do you need a spanish translator in the event we can provide legal consultation to you? *
Are you familiar with special education terms such as ARD and IEP? *