ALIYAH K-12 Special Needs Form
We value our students and honor the diversity of their individual needs and abilities. Please tell us about any concerns you have about your child, whether academic or social/emotional, that may affect your child's success in the ALIYAH learning environment.

Please Note: ALLERGIES and/or MEDICATIONS should be listed in the "Update Emergency Information" section of the ALIYAH Online Registration.

Student First Name *
Your answer
Student Last Name *
Your answer
Check if applicable: "I have no concerns about my child and s/he does not have an IEP at school."
Please explain any concerns you have for your child in the following areas. Include suggestions for accommodations that might improve your child's success
Academic Concerns:
Your answer
Social Concerns:
Your answer
Does your child have and IEP at his/her school?
If you don't know what this is, they probably don't have one. Your child does not have to have an IEP in order for you to list special needs.
If you answered "Yes," please list the accommodations provided by your child's school.
Your answer
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