Axt Legal Consultation Questionnaire

Consultation Request Form

Please tell me about your current situation. If my office is able to assist you, I will contact you to schedule a consultation. In the event I am unable to assist you, I am 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)?*

AutismDeaf-BlindnessDeafnessEmotional DisabilityHearing ImpairmentIntellectual DisabilityMultiple DisabilitiesOrthopedic ImpairmentOther Health ImpairmentSpecific Learning DisabilitySpeech Language ImpairmentTraumatic Brain InjuryVisual ImpairmentOther
Student's Disability*
Has a Due Process Case Been Filed Regarding This Matter?*

Yes, I filed a due process case against my child's districtYes, my child's district filed a due process case against meNo
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?*
Please Describe What You Would Like To Change About Your Child's Education & Your Desired Outcome*
What results are you hoping to achieve in the next 3-6 months?
What Do You Hope To Gain From Working With Me?*

I want to better understand how the special education process worksI want to feel more confident communicating with my child's school teamI want fast resultsI want to learn how to effectively advocate for my childI want someone to handle advocacy efforts for meI want to pursue legal action against my child's school districtOther
How Open Are You To Learning New Strategies, Even If They Challenge Your Current Beliefs About The Special Education Process?*

1 - I’ve done my research, I know what services my child should be getting, and I just need someone with authority to push the school to agree. I’m not really looking to change my approach or learn more about the system.2 - I’m overwhelmed and exhausted. I’d rather have someone speak for me and take over communication with the school so I don’t have to be involved more than necessary.3 - I want to understand the special education process and be more involved, but I feel lost or intimidated. I’d appreciate guidance and encouragement, even if I’m not confident yet.4 - I’m ready to understand how the system works, learn how to communicate better with the school team, and start advocating more effectively for my child—even if it takes time.
What Level Of Service Do You Seek?*

I just have questions and need guidance (one-time strategy session)I am looking for ongoing help with my child's IEP/504 PlanI am looking for an attorney to file a lawsuitI'm not sure
Referral Source*
Who May I 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