Strategy Session Request Questionnaire

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?

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.

What Have You Already Tried, and How Did the District Respond?

Please Describe Your Questions and/or Goals For Our Strategy Session

What Do You Hope To Gain From 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?

I understand that by requesting a Strategy Session, there is no guarantee that Sabrina Axt ("Attorney") will accept my case. I also understand that any opinion or advice given by Attorney is opinion only, based on the limited facts provided, and is cursory, non-binding, and not an absolute statement of law.

I understand that participating in a Strategy Session does not create an attorney-client relationship between me and Attorney. An attorney-client relationship is formed only upon execution of a signed Engagement Agreement. I further understand that Attorney has not 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.

Because no attorney-client relationship exists at the Strategy Session stage, 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.

Strategy Session Request Form