Confidential Contact Information
School Injury
(Fields Marked with a * are required)
1. *Parent(s) name:
2. Address:
3. City, ST, ZIP:
4. *Phone:
*(Home) (Work) (Mobile) (Fax)
5. *E-mail address:
6. School District:

7. Child's Name:
8. Age:
Current Grade:
 
9. Type of Education: Regular Education Special Education: (since) §504 Plan: (since)
9. Nature of Incident:
10. Where doctors and/or the ER involved? Yes No
11. Are the injuries permanent? Yes No If so, please describe:
12. Was an incident report created? .Yes No Do you have a copy? Yes No
13.Student had been out of school for days.
14. Steps already taken to resolve dispute (meeting with administration, manifestation hearing, school board hearing, etc.)
15. Have you ever consulted with, or at any time retained, other attorneys to represent you or your child as to this dispute, or any other dispute involving their education?     Yes     No
  A. If so, who did you retain or consult with?
Notice:
The attorneys that the Education Law Center refers potential clients to are all private practitioners. That means that they each have their own separate law practices and they each determine independently how they charge for their services (generally a set amount per hour, plus costs and expenses, with an initial retainer to start the representation).
       
   

Education Law Center, PLLC
www.michedlawcenter.com
Telephone (810) 227-9850 Facsimile (810) 227-7996
E-Mail: information@michedlawcenter.com
 
Disclaimer: The information provided on this web site is generalized in nature and is not a substitute for directly consulting with an attorney.
No attorney-client relationship is intended or established by the use of this site.
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