Beth M. Walsh, OTR/L Educational Advocate

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If you are human, leave this field blank.

If you would like to inquire about advocacy services for your child, please fill out the form below with as much information as you can provide. I will review the information and follow up with you within 24-48 hours.

Parent First Name

First

Parent Last Name

Last

Email *

Parent Phone Number *

Address *

Address Line 2

City *

State *

Zip Code

School District

Child's Diagnosis, Suspected Disability Or Other Concern

Students Age *

Students Grade *

Please describe Your Initial Concerns and Desired Result

Does the Student have an IEP or 504?

Yes, an IEP

Yes, a 504

No

OtherOther

Do you have documentation on your child's eligibility for services?

Do you have a partial rejection?

Yes

No

Date of partial rejection?

Are you seeking an out-of-district placement?

Yes

No

Have you retained an attorney?

Yes

No

Have you gotten a Neuropsych Evaluation?

Yes

No

Date of Neuropsych Evaluation?

Have you gotten a Neuropsych Evaluation?

Yes

No

Do you have safety concerns? If so, please describe them.

Please list your referral source

Contact:

Beth M. Walsh, OTR/L
Educational Advocate
office: 617-968-9631
email: beth@bethmwalsh.com