Parent Input Form, 2022-2023
SEPAC SOMA Board is collecting input from parents/guardians who are having difficulties related to their child's special education program or section 504 plan. If you need to speak directly with a SEPAC board member, please contact VP of Family Support, Ann Leeb: Thank you for sharing this information. We will be keeping track of what is included and share systemic concerns with administration.
Sign in to Google to save your progress. Learn more
Today's Date
Name (optional)
Grade of student
Clear selection
Student has ... 
Clear selection
Clear selection
Name of Preschool Partner or Out-of-District Placement school (if applicable):
Related to ...  (Check the one that MOST relates to the issue.)
Clear selection
Please describe the issue as plainly as possible. Include what action, if any, has been taken by the district. 
Would you like to or have you had contact with a SEPAC SOMA Executive Board member?
Clear selection
If you'd like to be contacted, please include your email below or email Ann Leeb directly at  
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy