Contact Form
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First Name
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Last Name
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Phone
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Email
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Address
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County of Residence
Bergen
Essex
Hudson
Morris
Passaic
Sussex
Union
Warren
Atlantic
Burlington
Camden
Cape May
Cumberland
Gloucester
Hunterdon
Mercer
Middlesex
Monmouth
Ocean
Salem
Somerset
District
School District of Residence
Child's Name
Child's Date of Birth
Classification Category
Auditory Impairment
Autism
Communication Impairment
Deaf/Blindness
Emotional Regulation Impairment
Intellectual Disability
Multiple Disabilities
Orthopedic Impairment
Other Health Impairment (e.g., ADD/ADHD, epilepsy)
Preschool Child with a Disability
Social Maladjustment
Specific Learning Disability (SLD)
Traumatic Brain Injury
Visual Impairment (including blindness)
Not Classified
Date of Last IEP Meeting (if applicable)
Have you been given an IEP in the last 15 days that takes something away?
Has a mediation request or due process petition ever been filed by either you or the school district?
Is there a pending mediation request or due process petition that was filed by either you or the school district?
Have you previously been represented by a special education advocate in this or any other matter? If so, whom?
Have you previously been represented by a special education attorney in this or any other matter? If so, whom?
How did you hear about me?
Online/Google
Facebook
Another Parent
Another Attorney
Advocate
School
Other
What are your primary concerns/desired outcome?
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