You must have JavaScript enabled to use this form. Admin Info First Date of Contact Year Year20202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Contact Intake Email Website Phone Fax Mail In Person Name (First and Last) * Email * Title Organization Name Address City State / Territory * StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingNot Available Phone Fax What is it you're looking for? * How would you describe yourself * How would you describe yourself?*PTIIndividual Parent/Family MemberCPIR StaffRegional PTAC StaffCPRC StaffSEA/Lead Agency DirectorDR Systems CoordinatorHearings CoordinatorComplaints CoordinatorMediation CoordinatorData Manager/StaffOther SEA/Lead Agency StaffSpecial Education DirectorSpecial Education TeacherGeneral Education TeacherService CoordinatorAdministratorPart C Administrator/StaffMediatorHearing OfficerAttorneyIEP FacilitatorComplaints InvestigatorTrainerConsultantCADRENICHCY StaffNASDSE StaffRRC StaffOSEP StaffOther TA&D Project StaffOther University| Law Student"|"Grad| University| Law Student"K-12 StudentProfessor/ResearcherMediation ContractorADR OrganizationParent Advocate Select the most appropriate response. Defining The RequestSubject of Request Continuum Participant & Stakeholder Training Stakeholder Council Early Resolution Options Facilitation Mediation Hybrid Models Ombudsperson Third-Party Opinion/Consultation Resolution Meeting Mediation Under IDEA Complaints Due Process Hearing Hearing Review (Tier II) Other Areas of Interest Advocacy APR/SPP Indicators CADRE info & products CADRE Website Early Intervention Evaluation/Data Help with Family/School Conflict IDEA/Regs Information/Referral Multi-cultural/Cross-Cultural Practitioner standards and professional development Research Rights/Procedural Safeguards Consultants Trainers/Training State Information Systems Change and Improvement Webinar Other Response Info First Date of Response Year Year20202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Staff Involved NoneAimee WalshDiana NadeauKelly RauscherMelanie ReeseNoëlla Bernal Response Media Email Website Phone Fax Mail In Person Is Response Complete Date Response Complete Year Year20202021202220232024 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Amount of Time Involved For Contact (in minutes) 0-15 16-60 61-120 120+ Referred to other Organization Other Comments Consent By clicking Submit, you are indicating that you have read and agree to our privacy policy.
