SCG Intake Form: Student Info Student's Full Name * First Name Last Name Preferred Name Student's Preferred Pronouns * He/him/his She/her/hers They/them/theirs Other Date of Birth MM DD YYYY Student's Email * Student's Cell Phone * Current School * Current Grade * Schools Previously Attended Please include name of school(s) and grades attended. Does the student have an Individual Education Plan (IEP) or a 504 plan at School? Yes No Has the student ever completed educational or psychological testing? Yes No If applicable, please share more about your child's learning differences and/or any current or past diagnoses. Is there any other information that you want to share that you didn't discuss on your initial call? Thanks for completing the intake form. If you need to fill out an additional form for another child, please use the link below to return to the intake form.Student Info Intake Form
