Contact – MassPAC – Federation for Children with Special Needs

Name of Caller (Parent/Guardian/Other)

First Last

Email*

Phone (to reach you between 10am and 3pm)*

If you are unavailable during our daytime Call Center hours, please indicate on the Intake Form that you would like to receive a call back during our weekly evening hours.

I would like to speak with someone about....*

Information Center Intake Form

Please fill out the form below, and we will do our best to respond by phone or email within two business days.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Relationship to child*

Child's Age

Child's Ethnicity

This data is collected for federatl grant purposes.

Child's Race

This data is collectred for federal grant purpose.

Is the child(ren) eligible for free/reducted school meals?*

Yes
No

School District*

Disability (Check all that apply)*

Hold down CTRL to select multiple options

Is the child on an IEP or 504 Plan?*

IEP
504 Plan
No

Do you have an IEP meeting, mediation or hearing currently scheduled?

Special Education Surrogate Parents

Let us know how we can assist you. Enter your question where indicated, and one of our Training and Support Specialists will contact you shortly.

Are you an appointed SESP?*

Yes
No

Are you interested in learning more about the Special Education Surrogate Parent Program?

Yes
No

SEPAC Inquiry

Is your SEPAC a current MassPAC member?

Yes
No

Would you like more information about MassPAC Membership?

Yes
No

Question/Comment

How can we help you?*

Please give us 2 business days to return your call. Thank you for your understanding

How did you hear about the Federation for Children with Special Needs?*

Which Program are you affiliated with?

Contact – MassPAC

Looking for more information about your local SEPAC?

Contact Us!

Federation Intake Form

Information Center Intake Form

Special Education Surrogate Parents

SEPAC Inquiry

Question/Comment

Your Support
Moves Dreams
Forward

Contact – MassPAC

Looking for more information about your local SEPAC?

Contact Us!

Federation Intake Form

Information Center Intake Form

Special Education Surrogate Parents

SEPAC Inquiry

Question/Comment

Your Support Moves Dreams Forward

Your Support
Moves Dreams
Forward