PC READS ADVOCATE PROGRAM: Assistance Request
Our Advocate Program strives to provide a personalized experience for families. Assisting families often includes reviewing both school and private assessments, explaining school procedures and services, and reviewing and revising IEP goals and 504 accommodation plans. Our Advocates have completed training through the Dyslexia Training Institute and are Certified Dyslexia Advocates. Please note that our advocates are not attorneys and are not providing legal advice or opinions.

After completing this form, a PC READS Advocate will contact you. Should you not hear from us within 2 weeks, please email Elissa Aten at elissa.pcreads@gmail.com. In addition to donations from private individuals, this program is supported by grants from the Park City Community Foundation, the Park City Rotary Club and the Bessie Minor Swift Foundation.
Email address *
Today's Date *
MM
/
DD
/
YYYY
Contact Information
Parent Name *
Parent Phone Number *
Parent Email address *
Parent Address *
Second Parent Name
Second Parent Phone Number
Second Parent E-Mail Address
Second Parent Address
Student Name *
Student's Current Grade *
Student's expected year of HS graduation *
Student's Current School *
Student Situation
Please check all below that are applicable: *
Required
Please provide a brief summary of your child's current situation and the reason for your concerns. If you chose "other" for grade or school above, please include specific information here.
How did you learn about us?
Do you receive the PC READS E-News? *
How did you learn about the PC READS Advocate Program? *
Required
If someone personally referred you to PC READS, please consider sharing their name with us. Thank you!
If you are completing this form on behalf of a student and you are not their parent, please provide your name, email, phone number and mailing address below. Also, please include your relationship to the student (guardian, friend, etc.) Thank you!
Disclaimer
I understand that PC READS' Advocates are not attorneys and are not providing legal advice or opinions. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy