CarmenCarley@gmail.com
Contact Us
South Bay Child Advocates
1003 Beech Avenue
Torrance, CA 90501
(310) 951-0774 or CarmenCarley@gmail.com


If you would like more information particular to your case, please fill out the new client intake form below. With the information provided, we will set up a free consultation (approximately 30 minutes) by phone or in person to see if it is the right time to have SBCA represent you. During this consult we will give you suggestions for your case, a description of our advocacy services and fees, and answer questions you might have.
Copyright 2010 South Bay Child Advocates: Advocate for Special Education.
All Rights Reserved.
SBCA INTAKE FORM:     ( * required field )

Parent(s) name:

Phone:

Best phone number to contact:

Best time to call:

Email:

Child's name:

Child's age:

Child's date of birth:

Child's diagnosis if any:

First diagnosed by:            Date:

Pursuant diagnoses:  Date(s):

School District:
Eligibility Category for Special Education if applicable:


Placement (e.g. general education or special education classroom):


Services currently provided by School District:


First referral to Special Education Date:


First IEP date:

Most recent annual IEP date:

Most recent amendment IEP date:


Last School District evaluation date:


Regional Center:
First referral to Regional Center Date:


First found eligible/ineligible:

Eligibility category if applicable:

Last IFSP (/IPP) date:

Services currently provided by Regional Center:


Please describe what issues you are having with your School District and/or Regional Center:






Please describe what remedy you are seeking?


Is there any other information you would like to share?
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