Parent Request Form for SpEd

This form is available in English and Spanish. Click on the top right and choose your language of preference.

Este formulario está disponible en Inglés y Español. Haga clic en la parte superior derecha y elija el idioma de su preferencia.
Parent Request Form

for Special Education Advocacy
Are you a new consumer of our services?*

YesNo
If you have received services from us before, when was the last time you contacted us?*
Today's Date

MonthDayYear
Date
Parent/Guardian Legal Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
County:*
Click on arrow to change default selection if needed.
Phone:*
Cell or Home
Parent's Email
example@example.com
Referred by:
If person is from an agency, please include.
Child's Legal Name:*

First NameMiddle Name or InitialLast Name
Child's Sex:*

FemaleMale
Child's Pronouns
he/him, they/them, she/her...
Child's Age:*
School District:*
School:*
Grade:*
Please check ALL disabilities that apply/relate to your CHILD.

At least one disability MUST be selected. You do not have to have a formal diagnosis for the child:
COGNITIVE DISABILITY:*

N/AIntellectual DisabilityTraumatic and Other Brain InjuriesLearning DisabilityAutismOther Cognitive Disability
MENTAL HEALTH:*

N/APsychiatric DisabilityEmotional/Behavioral disabilitiesOther Mental Health
PHYSICAL DISABILITY:

N/ASpinal Cord InjuryNeuromuscularOrthopedicCerebral PalsySpina BifidaEpilepsyMuscular Dystrophy/ Multiple SclerosisOther Physical Disability
SENSORY DISABILITY:*

N/ABlindnessLow VisionDeafHard of HearingDeaf & BlindOther Sensory Disability
Criteria to prioritise at-risk student cases SE Advocacy: In order to meet the increasing and complex needs of our consumers, and to more efficiently provide advocacy support to families with urgent needs, we have implemented a procedure to triage our services. TRI does not maintain a waitlist of families who contact us for srvices and the estimated time for our advocactes to return phone requests for services is approximately 5 to 10 business days; however, TRI Special Education Advocates will prioritize at-risk student cases according to the following criteria: PLEASE CHECK ALL THAT APPLY TO YOUR CHILD:

Suspension/Superintendent HearingManifestation Hearing, significant Behavioral IssuesMental Health, Pending Placement on Limited Home InstructionSeeking Initial EligibilityChild Protection or Court Ordered casesHomeless or Foster Placed StudentsHigh Medical NeedsNYSED Target School- In Need of Improvement or AssistanceInquiring about OPWDD Services/EligibilityIn Progress receiving OPWDD ServicesApproved for OPWDDReceiving Self-DirectionDenial for School InclusionDenial for Community InclusionTargeted Harassment or Bullying in School (DASA)PINS (Person in Need of Support)
Can you please expand on your selection above?*

0/1400
Does your child have an IEP?*

YesNo
What is the date of your child's latest IEP?

MonthDayYear
Date
Do you have any updated evaluations (IQ, Behavioral, etc)?*

YesNo
Do you have any upcoming school meetings?*

YesNo
If yes, specify date.

MonthDayYear
Date
What time is your School Meeting? (EST)
include AM or PM
If you have any documents you would like to send us, you can upload them below.

File can not be more than 5MB
Cancelof
Should be Empty: