Welcome
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What questions can we answer?
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Email
Phone
Text
About the Student
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Gender
Date of Birth
mm/dd/yyyy
Current Grade
Not yet in school
Preschool
K
1st
2nd
3rd
4th
5th
6th
7th
8th
ASD Level Diagnosis
1
2
3
For more information the programs we offer please visit the following links:
Weekday School Program
Summer Program
Interested in School Program
Weekday
Summer
Interested in Grade
Preschool
K
1st
2nd
3rd
4th
5th
6th
7th
8th
For the Fall of
2024-2025
Current School
About the Parent/Guardian
Name
Mr.
Mrs.
Ms.
Dr.
Title
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Student
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Guardian
Primary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from Cyzner Institute. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to .
Yes
No
Secondary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from Cyzner Institute. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to .
Yes
No
Email
Mailing Address
County
Union
Mecklenburg
Cabarrus
Gaston
Iredell
Stanly
Lancaster
York
Chesterfield
Current Services
What services is the student currently receiving?
ABA
LCSW
OT
Speech
ABA Frequency
LCSW Frequency
OT Frequency
Speech Frequency
Thanks for reaching out! Out of curiosity...
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