Advocacy Support Intake Form

Before You Begin

Thank you for considering my Advocacy Support services. Please note the following before you begin:

Filling out this intake form is an important step in determining if we are the right fit for each other. Completing this form does not establish a client relationship or guarantee that I will be able to take on your case. It’s essential that my philosophy and approach align with your goals to ensure the most effective and supportive experience for you and your child.

I am a solo consultant who works with each family to provide individualized support. As a result, availability for intake calls can vary. Sometimes I can offer immediate availability, but there may be a 2 or more weeks wait. If your needs are urgent, I may be able to support you sooner. Please complete the intake form as early as possible to ensure timely assistance.

Once I have reviewed your form, I will reach out to discuss the next steps if we are a good match and my availability matches your needs.

Are you looking for a one-time consultation to help you make a decision about your child’s education or to understand your options? Book an Educational Guidance Session.

24/25 Advocacy Support Intake Form

Parent/Guardian Information

Child information

Location & School District Information

Advocacy Support Overview

Payment Method

AFU Clients: To ensure we can begin our work promptly, please submit a Request to Pay (RTP) for 5 hours of work at $135/hour (totalling $675) and obtain approval from the Autism Funding Unit. This step is crucial for a smooth start to our collaboration. Please note that processing can take up to 6 weeks, so I recommend submitting your RTP as soon as possible to avoid delays.

Consent & Privacy

I am committed to protecting your privacy and ensuring the confidentiality of your information. By submitting this form, you consent to me collecting and using your information to provide advocacy support services. Your information will be kept confidential and not shared without your consent.