Free Advocate Evaluation Request
Was your child denied IHSS services? Get a free evaluation of your child’s Protective Supervision case from one of our knowledgeable IHSS advocates.Tell us about your child’s Protective Supervision case by filling out the following questionnaire. Once you submit your questionnaire we will contact you within 48 hours.* Denotes a required field
Name of Caregiver
*
First Name
Last Name
Name of Child
*
First Name
Last Name
Date of Child's birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Number of current IHSS hours
*
Have you applied for Protective Supervision?
*
Yes
No
Why does your child require Protective Supervision
*
Any questions or other things you'd like to tell us
Submit
Should be Empty: