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 a Phone Consulation - Special Education Advocacy
Submitting this Parent Request Form for TRI's Special Education Advocacy Services puts you in the queue for a phone consultation to determine eligibility for advocacy services.

A phone consultation is the first step for new and returning consumers.

There is no guarantee that an advocate will be available to speak with you before your next school meeting.

Please note that uploading and sharing information does NOT guarantee your enrollment in the program.
Are you a NEW consumer of our services? Meaning you never completed a Parent Intake Packet*

Yes- I never completed a Parent Intake Packet for this child/studentNo - I have completed the Intake for this individial child/student in the past.
If you have received services from us before, when was the last time you contacted us?*
or type, "first time", "today", "N/A"
Name of the SE Advocate you had worked with in the past*
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 services and the estimated time for our advocactes to return phone requests for services is approximately 2 to 3 weeks; however, TRI Special Education Advocates will prioritize at-risk student cases according to the following criteria. We understand the importance of finding your child's right services or an education plan. We're here to help. Our dedicated team provides families valuable guidance and support in seeking services related to these ares. PLEASE CHECK ALL THAT APPLY TO YOUR CHILD:

Suspension/Superintendent HearingManifestation Hearing, significant Behavioral IssuesHomeless or Foster Placed StudentsTargeted Harassment or Bullying in School (DASA)Mental Health, Pending Placement on Limited Home InstructionChild Protection or Court Ordered casesDenial for School InclusionDenial for Community InclusionSeeking Initial EligibilityHigh Medical NeedsNYSED Target School- In Need of Improvement or AssistanceInquiring about OPWDD Services/EligibilityApproved for OPWDD (provide the TABS# below)Receiving Self-Direction (provide the TABS# below)In Progress of receiving OPWDD Services - meaning you called OPWDD's Front Door and/or submitted their application
OPWDD TABS#: blanks* . Child's Medicaid #: blank* .
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 are a RETURNING CONSUMER, and you have any recent documentation you would like to send us in advance, you can upload them in PDF format below. Files must be in a PDF format and less than 5MB combined. Additonal documents please send to ** SEDocuments@taconicresources.org ** with the students name in the subject line, along with your full name in the body of the email. ***As stated in the begining of this form, submitting documentation does NOT guarantee your enrollment in the program***

File can not be more than 5MB
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