Events

PRTF Contact Form

*Please allow 1 week for a response.

Name

Relationship to Child

Phone

Message

Student Information

Age

Sex

IEP Designation

IQ and Academic Level

Does the child have a formal diagnosis of an intellectual or developmental disability?

Please list diagnosis:

Please explain any medical conditions:

Please explain other mental health issues

State Student Resides In

Current Placement

Anticipated Funding Source

Insurance

Further information