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FOR CLIENTS IN THE COUNTIES OF INDIANA AND ARMSTRONG, IN PENNSYLVANIA
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CONTACT INFORMATION Name: Relation to Student: Telephone: Email: Contact Preference: PhoneEmail How did you hear about us? Are you located in Indiana or Armstrong county, Pennsylvania?
STUDENT INFORMATION Student Name: Student's School: Student's Age: Student Currently Has: IEP504 Plan
PRESENT CONCERNS LEADING TO ADVOCATE INTAKE Please describe in detail what steps you have taken prior to reaching out to The Arc to alert those working with your student about your concerns and possible solutions with your IEP/504 team, teacher, principal, or Special Education Director Please describe in detail the concerns and goals you would like to address to ensure your student's educational success:
CONTACT INFORMATION Name: Email: Telephone: Contact Preference: PhoneEmail
CONCERNS Please describe in detail the questions / needs / concerns and other information to include so that we can best assist you
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