Request for Services
The purpose of this process is to offer families support with navigating the special education system in the state of New Mexico. This form should be completed when a student or family are struggling with rules, regulations, policies, or procedures and school based or district based personnel are unable to assist them. Please answer this form completely and the office of the Ombud will contact you within 72 hours to verify the information shared, and obtain additional details. We will then work with you to determine the referral process, or possible solutions for the issue/concern. All information shared with the office of the ombudsperson is confidential. Information will be gathered for support and data collection purposes, no personnel or private information will be shared without your approval.
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Email *
What is the email of the person completing this form? *
What is the last name of the person completing this form? *
What is the first name of the person completing this form? *
What is your phone number? *
What is your preferred mode of communication? *
What is your relationship or position to the student? *
What is the last name of the student? *
What is the first name of the student? *
What is the age of the student? Grade Level?
What is the disability or eligibility?
In which district does this student attend school?
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What is the name of the school the student attends? *
Which county is the school district located?
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13. Has the issue/concern been brought to the attention of: (Please check all that apply) *
Please provide a brief summary of the issue and tell us how the issue/concern is impacting your student’s progress. *
What significant dates and events are relevant to this issue/concern which would help us to better understand? *
Please describe your solution for this issue/concern. *
A copy of your responses will be emailed to the address you provided.
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