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GROUP SUPPORT EVENTS
Thank you for your interest!
By submitting this form, you will be added to our interest list.
Our team will carefully review your choices and follow up with you based on your selected payment type.
✉️You will receive a follow-up email from
enrollment@eesupportservices.com
We are thrilled to offer this support type to you and your family!
Date of Inquiry
*
Year
/
Month
/
Day
Parent/ Guardian Name
*
Your first and last name
Email
*
Your email address
Phone Number
*
Your phone number
Payment Type
*
DDD Authorizations
Private Pay/Direct Pay
If you selected DDD as your preferred payment option, have you already gone through the DDD process and have been approved for services? (required to utilize DDD)
*
Yes
No
I am requesting services for my child, who is currently enrolled at PS Academy Arizona (this is just as an FYI for us.)
*
Yes
No
Client First Name
*
For whom
you're requesting services
Client Last Name
*
For whom you're requesting services
City
*
Does the client have neurotypical siblings interested in attending EE Group Support Events?
*
Siblings do not need a diagnosis to attend our events, however they must be of kindergarten age.
Yes
No
Additional Comments
Referral Source
*
Please Select
School/Program
DDD/Support Coordinator
Facebook/Instagram/Social Media
Google / Key Word Search
Family Member or Friend
Other
Submit