Special Education Due Process Hearings & State Complaints

Wednesday, November 28, 2018

10:00am-12:00pm

East Bank Regional Library

4747 W. Napoleon Ave.

Metairie, LA 70001

I am attending this training as a(n)

Parent/Guardian of a child with a disabilityEducatorProfessional - Non EducatorYouth with a disability - under 18Adult with a disability - over 18

First Name

Last Name

School or Organization Name

Job Title

Preferred Phone

Work Phone

Mobile Phone

Can we text this number?

Yes - ok to textNo - do not text

Home Phone

Address Type

Mailing Street

Mailing City

Mailing State

Mailing Zip

Parish

Demographic Information

What is the IEP primary exceptionality for the child/student with disability?

AutismDeaf-BlindnessHearing ImpairmentDevelopmental DelayEmotional DelayIntellectual DisabilityMultiple DisabilitiesOrthopedic ImpairmentOther Health ImpairmentSpecific Learning DisabilitySpeech or Language ImpairmentTraumatic Brain InjuryVisual Impairment - BlindnessInappropriately IdentifiedSuspected or not yet identifiedGifted/TalentedAll Disabilities504 Plan - check here if child has 504 plan

Birthdate of child with disability (XX/XX/XX)

If you have more than one child with a disability, please provide additional information here

As a grant requirement, we are expected to provide support and training to all individuals. Therefore our grant requires us to report on the following ethnicity question:

Do you consider yourself

African-AmericanAsianCaucasian/WhiteHispanic/LatinoNative AmericanNative Hawaiian/Pacific IslanderOtherI prefer not to answer

Special Accommodations: please list any special accommodations needed to fully participate in this event.

Email newsletter

Yes! Please add me to your email listNo thank you

Contact Record Type (hidden)

Contact Information