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Si Hablamos Espanol.

SPECIAL EDUCATION ADVOCACY SERVICES, LLC

Educational Advocacy and Support
Adult/Transition Support
Services
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Forms and Payment

Potential clients - Clientes potenciales

* Indicates required field

Parent/Guardian Name - Nombre del padre/tutor *

First

Last

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Parent/Guardian Name - Nombre del padre/tutor *

First

Last

Address - Direccion *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number - Numero de telefono *

Email - Correo electrónico *

Email- Correo electrónico *

Student's Name - Nombre del estudiante *

First

Last

Date of Birth (MM/DD/YYYY) - Fecha de Nacimiento *

Current grade level - Nivel de grado actual *

Previously retained - Previamente retenido *

If Yes, what grade level - Si respondio que si, indique el grado repetido *

Current school your child attends - A que escuela asiste su hijo/a actualmente? *

Medical diagnoses - Diagnostico medico *

How did you hear about Ysela Heim and/or Special Education Advocacy Services, LLC- Como te enteraste de nosotros *

Do you prefer to speak with a Spanish Speaking Advocate? -Usted prefiere hablar con un defensor de educación en Espanol? *

Have you ever worked with an Educational Advocate or Attorney? - Alguna vez ha trabajado con un abogado o defensor de educacion? *

Is your child currently receiving any of the following? - Esta su hijo/a recibiendo actualmente alguno de los siguientes soportes? *

Tutoring - Tutoria ABA Therapy - Terapia ABA Speech/Language Therapy -Terapia de habla y del lenguaje Occupational Therapy - Terapia ocupacional Physical Therapy - Fisioterapia Social Skills Classes -Clases de habilidades sociales Vision Therapy - Terapia de la vision Neuro/Cognitive Feedback -Retroalimentacion neurocognitiva Feeding Therapy - Terapia de alimentación Other - Otra

Concerns that you would like assistance with - Inquietudes para las que busca ayuda? *

Submit

Are you a professional with questions or would you like to collaborate and network?
Contact Ysela Heim at [email protected] or office # is 954-249-2614.