IEP/Evaluation Review - Limited Special

Parent/guardian full name*

Relationship to student

Email address*

Student's full name*

Student's date of birth*

Student's current grade level*

School/district/state*

Service Selection (Select only one package. Both offers include a written feedback summary, suggested IEP-team questions, a parent introduction letter, and review of a current BIP if applicable.)*

Option A - $75 | IEP Review Special (30-minute consultation)

Option B - $100 | IEP + Evaluation Review Special (46-minute consultation)

Areas of concern*

Academic performance/learning

Dyslexia/other learning disability

Attention/executive functioning

Autism/communication & social needs

Behavior/emotional needs

IEP goals/progress monitoring

Accommodations/modifications

Services/placement/related services

Other

If 'other', please explain.

Main question or concern (briefly describe)*

Additional questions/concerns

Required Documents: 1) Current complete IEP 2) Most recent evaluation/reevauation - Option B only) 3) Current BIP, if applicable*

I agree and will provide the required documents.

IEP Review & Consultation Terms: • The written feedback summary will be delivered within five (5) business days after DLS receives full payment, a completed intake form, and all required readable documents. Weekends and recognized business holidays are excluded. • The included consultation must be scheduled and completed within thirty (30) calendar days after the written feedback summary is delivered. Appointments are subject to availability; interpretation may be requested in advance, subject to confirmation. • The service is a review of documents provided by the family, not an independent evaluation, medical assessment, legal assessment, or determination of eligibility, placement, services, or accommodations. • DLS cannot guarantee a particular school decision, change to an IEP, eligibility result, or educational outcome.*

I understand and agree.

Important Legal Disclaimer: Dynamic Learning Solutions and its educational consultants are not attorneys. DLS does not provide legal advice, legal opinions, legal representation, or attorney-client services. Written feedback, observations, suggested questions, and consultation discussions are educational and informational only. Discussion of IDEA, Section 504, parent rights, or special education procedures is not individualized legal advice. Families seeking legal guidance about disputes, deadlines, complaints, due process, or possible violations of law should consult a qualified licensed attorney.*

I understand that DLS provides educational consulting and advocacy support, not legal advice or representation.

Confidentiality & Authorization (please check both statements below): I confirm I am the student's parent, legal guardian, or otherwise authorized to provide these records, and I authorize DLS to review them for the purchased service. DLS will use submitted student records to provide the service and related administration, with reasonable safeguards and according to its applicable privacy and retention policies. DLS will not contact the school as part of this review without separate authorization, except where disclosure is legally required.*

I am authorized to submit the student's educational records and consent to their review.

I understand the stated confidentiality and records-handling terms.

Payment, Cancellation, & Refunds: • Full payment is required before the review begins. Promotional rates apply to eligible enrollments completed by December 1, 2026. • A full refund may be requested within 24 hours of DLS receiving records sent by you (parent/guardian). After this 24-hour receipt period, a refund will not be provided unless DLS is unable to complete the services described in this agreement. • If DLS cannot provide the purchased service, the family will receive a refund for services not performed. Please allow a 5- business day period of receipt of student records before scheduling a consultation. • Missed consultation appointments may be rescheduled at DLS's discretion within the original 30-day consultation period. Unused consultation time is not credited toward other services. • Additional services or fees require a separate agreement and approval.*

I understand and agree

Required Acknowledgements - Please acknowledge each statement below.*

I understand my selected package and what is and is not included.

I understand the five-business-day timeline begins only after all required items are received.

I understand the consultation duration and 30-calendar-day completion requirement.

I understand DLS does not guarantee any school or educational outcome.

I agree to the payment, cancellation, and refund terms.

I have read and agree to this entire enrollment and service agreement.

Parent/Guardian Agreement & Consent: By typing my full name below, I intend to sign this agreement electronically and consent to use of an electronic signature for this transaction.*

Consent Date*