Inquire Online - Academy for Young Minds

ONLINE INQUIRY

Please complete the following Inquire Online form to tell us more about your child and help us determine general appropriateness for the placement at AYM.

After initial screening, please be aware that you will need to complete the AYM Application Packet and possibly submit additional documents/information as needed (e.g., IEP, reports, evaluations, medical history, etc.).

Online Inquiry

Family Information

First Name *

Last Name *

Relationship to Child *

Email *

Phone *

Street *

City *

State *

Zip Code *

Child Information

First Name *

Last Name *

Date of Birth *

Gender *

Boy

Girl

Grade *

Age *

Diagnosis *

Current Placement *

Program *

Assessment *

Neuropsychological Evaluation *

Name of Neuropsychologist: *

Date of Scheduled Evaluation (xx/xx/xx) *

SPED Attorney *

Name of Attorney: *

Why AYM?

Please kindly share why you are seeking for a private placement.

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ONLINE INQUIRY

Family Information

Child Information

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