Strategy Session Request Questionnaire

I understand that by requesting a Strategy Session, there is no guarantee that Sabrina Axt ("Attorney") will approve a Strategy session or accept my case. If Attorney approves a Strategy Session, that does not automatically mean Attorney will offer ongoing services. Attorney will keep the information I provide on this form confidential.

If Attorney approves a Strategy Session, Attorney will provide legal advice for that session only. The session includes review of up to 50 pages of documents and one 45-minute meeting. Our attorney-client relationship is limited to the Strategy Session and ends when the session ends. I also understand that any opinion or advice given by Attorney is opinion only, based on the limited facts I provided, and not an absolute statement of law.

Ongoing services, if offered, require a separate Engagement Agreement signed by both me and Attorney and separate payment. I understand that I may not identify Attorney as my attorney or representative, and I may not include Attorney on any correspondence, communication, or meeting with my child's school, district, or any other service provider, unless and until a signed Engagement Agreement is signed.

Parent/Guardian Name

First NameLast Name

Email

example@example.com

Cell Phone Number

Format: (000) 000-0000.

Student's Name

First NameLast Name

Student's Birthdate

MonthDayYear

Student's Grade Level

Current School of Attendance

School District

Does Student Have an IEP or 504 Plan?

Date of Last School Evaluation

MonthDayYear

Student's Eligibility Category(ies)?

Student's Disability

Has a Due Process Case Been Filed Regarding This Matter?

Other

Please Describe Your Specific Issues & Concerns Regarding Your Child's Education.

Other Than You, Who Sees This As An Issue?

e.g., private therapist, outside evaluator, pediatrician, classroom teacher, etc.

Has Anyone Other Than You Raised This Concern In Writing?

Please identify anyone who has raised this concern in writing.

What Have You Asked the District For in Writing, and How Did It Respond?

What Do You Hope to Gain From Our Strategy Session?

Please include specific questions your would like me to answer during our Strategy Session

Which of the Following Best Describes What You Are Looking For Right Now?

What Would You Like to Cover Our Strategy Session?

Other

How Open Are You To Learning New Strategies, Even If They Challenge Your Current Beliefs About The Special Education Process?

What Level Of Service Do You Seek?

Referral Source

Who May I Thank For Referring You?

Strategy Session Request Form