Tell Us About Your Student

In an effort to be fully prepared to speak with you, possibly convene with the most relevant specialists from our staff for your student and make the most of an intake meeting, we ask that you help us prepare by filling out this brief form.

Name of Parent/Guardian*
First Last
Name of Student
First Last
Age
Address
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Current School/Program
Have you received approval from your home district to seek an out-of-district placement?*
- Yes
- No
Who/how were you referred to us?
Describe your student's disability(ies):
Is this student on the autism spectrum?
- Yes
- No
Please explain:
What brings you to want to consider The Deron School?