NAD - Education Advocacy Information Intake

Note: This form is for Birth-12th grade deaf of hard of hearing children, their families, teachers, early intervention services, and schools. If your situation is related to employment access, post-secondary training, please go back and select “Law and Advocacy”. If your situation is related to publishing books or sharing resources, please select “Other”.

Name*
First Last
Email*
Phone*
Type of phone*
Question or comment*
(please include any dates we need to be aware of)
Where are you located?*
City State ZIP Code
Name of School or District*
This is regarding*
I need help with*
Area of concern*
I am*
Child's age*
Child's grade*
Is the child deaf or hard of hearing?*
What other disabilities does the child have?
What type of process is the child currently in?*
Are you or your child already represented by a lawyer?*