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Special Ed: What Parents Need to Know 11.12.2020
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1.
Please provide your contact information.
(Required.)
Name
Email Address
Phone Number
2.
What county do you live in?
3.
What is your race?
Black or African American
White or Caucasian
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Multiple Races
4.
What is your ethnicity?
Hispanic or Latino
Non-Hispanic or Latino
5.
Please provide your child's date of birth.
Date of Birth
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
6.
What is your child's race?
Black or African American
White or Caucasian
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Multiple Races
7.
What is your child's ethnicity?
Hispanic or Latino
Non-Hispanic or Latino
8.
What is your child's diagnosis? Please check all that apply.
Autism
ADD/ADHD
Deaf/Blind
Developmental Delay
Intellectual Disability
Deaf/Hearing Impairment
Emotional Disability
Learning Disability
Multiple Disabilities
Other Health Impairment
Orthopedic Impairment
Speech & Language
Traumatic Brain Injury
Vision Impairment/Blind
Suspected Disability
None
Other (please specify)