Client Intake/Formulário de Ingreso del Cliente
Thank you for connecting with Learning & Educational Solutions Inc. We’re committed to supporting students and families with the resources, guidance, and programs they need to succeed academically, socially, and emotionally.

Please complete this short intake form to help us understand your needs and match you with the right services. An LES team member will contact you soon after submission.


Gracias por comunicarse con Learning & Educational Solutions Inc. Estamos comprometidos a apoyar a los estudantes y las familias con los recursos, la orientacion y los programas que necesitan para tener exito academico, social y emocional.

Por favor, complete este breve formulario de admision para ayudamos a comprender sus necesidades y conectario con los servicios adecuados. Un miembro del equipo de LES se comunicara con usted poco despues de enviar el formulario. 

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Email *
Parent/Guardian Full Name/ Numbre completo del padre/madre o tutor (a) *
  Parent/Guardian Phone Number/ Numero de Telefono del padre/madre o tutor(a)  *
Student's Full Name/ Nombre completo del estudiante *
 Student's Current School/ Escuela Actual Del Estudiante *
Student's Age & Grade/ Edad y Grado Del Estudiante *
  Services Needed/ Servicios Necearios *
Required
  Preferred Method of Contact/ Metodo de contacto preferido  *
Required
Notes or Additional Information/ Notas o Informacion adicional *
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