Axt Legal Consultation Questionnaire

Consultation Request Form

Please tell us about your current situation. If my office is able to assist you, we will contact you to schedule a consultation. In the event we are unable to assist you, we are happy to provide a referral to another resource who may be able to help you.
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Student's Name*

First NameLast Name
Student's Birthdate*

MonthDayYear
Date
Student's Grade Level*
Student's Grade Level*
Current School of Attendance*
School District*
School District*
Does Student Have an IEP or 504 Plan?*

IEP504 PlanMy child does not have an IEP or 504 Plan, but I think they need oneMy child does not have any special education needs
Date of Last School Evaluation

MonthDayYear
If your child's school district has evaluated your child for special education eligibility, please provide the date of the last evaluation.
Student's Eligibility Category(ies)?*

AutismOther Health ImpairmentSpecific Learning DisabilitySpeech Language ImpairmentEmotional DisturbanceIntellectual DisabilityOther
Student's Disability*
Please Describe Your Specific Issues & Concerns Regarding Your Child's Education.*
What Are You Currently Doing To Address Your Issues & Concerns Regarding Your Child's Education?*
How Would You Like Us To Help You With Your Issues & Concerns Regarding Your Child's Education?*
What results are you hoping to achieve in the next 3-6 months?
What Type of Service Are You Interested In?*

I just have questions and need guidance (consultation only)I am looking for a Special Education AdvocateI am looking for a Special Education AttorneyI'm not sure
Referral Source*
Who May We Thank For Referring You?
I understand that by requesting a consultation, there is no guarantee that Axt Legal will accept my case. I also understand any opinion or advice given by Axt Legal is opinion only, based on the limited facts provided, and is cursory, non-binding, and not an absolute statement of law. I further understand that Axt Legal has not yet been retained to represent me and will take no further action on my behalf unless a separate Engagement Agreement is signed by both parties. Representation, if offered, requires a separate contract and payment.
Should be Empty:

Consultation Request Form