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We would love to hear from you! Please fill out the form below and a member of our team will get back to you within two business days.

Inquiry Form

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What is the nature of your inquiry?required

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Namerequired

First Name

Last Name

Email Addressrequired

Phone Number

Must contain only numbers

Relationship to Studentrequired

Subjectrequired

Please describe the nature of your inquiry

Messagerequired0 / 1000

I am seeking:requiredPlease select up to 1 choice

Immediate Placement (24-25)

July '25 Placement

September '25 Placement

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Student Namerequired

First Name

Last Name

Student Gender (Identified)required

Student Date of Birthrequired

Must contain a date in M/D/YYYY format

Current School/Programrequired

Please note the details of the setting ex. ICT class at PS 1. If none, put n/a.

Is your child currently receiving private services or services through CPSE?Please select up to 1 choice

Yes, my child receives private services

Yes, my child receives services through CPSE

No, my child is currently not receiving services outside of school

No, my child is currently not receiving any services at all

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If your child is receiving services privately or through CPSE, please state the organization you're receiving services from:

Name of Neuropsychologist

If applicable

Name of Developmental Pediatrician

If applicable

How did you hear about The Shirley Aninias School?required

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