Name *

First Name

Last Name

I have reviewed the privacy policy, terms of use, and disclaimer found at www.apathfrowardadvocate.com *

Yes

Today's Date *

MM

DD

YYYY

Which School District does your child attend? *

Hall County

Gwinnett County

Buford City Schools

We are out of district

We do not attend a GA school

Which category does your child receive special educatoin services. (check all that apply) *

Autism

Deaf/Bline

Emotional and Behavioral Disorder (EBD)

Intellectual Disability (MID, MOID, SID, PID)

Orthopedic Impairment

Other Health Impaired (ohi)

Significant Developmental Delay (SDD)

Specific Learning Disability (SLD)

Speech-Language Impairment

Traumatic Brain Injury

Visual Impairment

Occupational Therapy (OT)

Have you previously worked with another advocate or lawyer? *

Yes

No

Do you currently have an IEP or school meeting scheduled? *

Yes

No

If yes, what is the date of your meeting?

MM

DD

YYYY

The initial service package to get started is $350. The remainder $450 will be due within 30 days or our initial conversation. *

Yes

No