New Clients — Spectrum Advocacy

Let’s advocate together

Interested in our advocacy services? Fill out some information and we will be in touch shortly! We can't wait to hear from you!

New Client Form

Name

First Name

Last Name

Phone

(###)

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Preferred Contact Method

Student's Full Name

Please provide student's information (if applicable)

Age/Grade of Student

School Student is Attending

Current Special Education Status

If known

If different from the client, please enter the following information

First Name

Last Name

Relationship to Student

Phone

(###)

###

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Advocacy Details

Briefly describe the reason for seeking advocacy services

Educational History

Has the student received special education services before? If yes, please provide a brief history

Documentation Available

Do you have any relevant documents, such as IEPs, assessments, or correspondence with the school? If yes, please list:

Preferred Outcomes

What specific outcomes or changes would you like to achieve through advocacy?

Referral Source

If applicable

Availability for Consultation

Please list the best days/times for initial consultation

Privacy and Consent

I understand that the information provided will be treated confidentially and used for the purpose of advocating for special education services.

Yes