* indicates a required field
Please provide us with information about your education by answering the questions below.
(ie. Chromebook, iPad, Screen Reader, Hearing Amplifier, LiveScribe Pen, etc.)
Diagnosis/Medical Condition/Disability & Documentation
In this section please provide specific details about your diagnosis, and how it impacts your ability to function in an educational setting.
Upload supporting document(s)
If you would like us to reach out to your provider on your behalf for your documentation, please include the name(s), phone number(s), and fax number(s) for each. Professional providers may include: medical providers, psychologists, educators, VR professionals, etc.