Online Child Find Project Contact Form

If you have concerns regarding the development of a child and need more information about special education services, please fill out the following contact form and one of CPAC’s Parent Consultants will contact you within 24 hours of your request. Submitted information is confidential. Please specify if you need bilingual assistance (Spanish).

How did you hear about the Child Find Project at CPAC?

If you selected Other, please provide details:

Child's Information:

First Name:

Last Name:

Date of Birth:

Grade Level:

Gender:

School District:

Please give a detailed description of the child's concern/reason for contact:

Parents' Information:

Parents' First Names:

Parents' Last Name(s):

Primary Language:

Daytime Telephone:

Street Address:

City:

State:

Zip Code:

Email Address:

Your Information (If other than parent):

Your relation to the child: