* 1. What is your contact information?

* 2. What is your child(ren)'s name, age, gender?

* 4. Please share any information, concerns, or ideas about your child.

* 7. Do you have any friends, neighbors, classmates, or church members who might benefit from this program? (whether the Special Needs or Leadership & STEM Academy) If so ... please share their contact information to we can extend a personal invitation!

* 9. Is there anything else you want to share or discuss with us?