How are we Doing? |

Student's Name *

Parent's or Guardian's Name *

County of Residence *

School District *

School of Attendance *

Does your child have an Intellectual/Developmental Disability? *YesNoRequesting Evaluation

Please describe your child's diagnosis

Does your child have an IEP? *YesNoRequesting Evaluation

What was the advocacy goal for your student? (Reason you contacted The Arc of Southwest CO) *

Has the advocacy goal been met? *YesNo

How often would you like your Education Advocate to follow up with you?

Best way to contact you *PhoneEmailTextU.S. Mail

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Would you like information on our support groups?YesNo

Supported Decision Making and Guardianship info and processTransition PlanningSpecial Needs Trusts and set up

How did you hear about us? *