Print out, fill in the requested information, make a copy for your files, and email it to me as part of your Healthy Kids Advocacy Packet. Send to ellie.goldberg@healthy.kids.info
CHILD'S CASE HISTORY: For your child's advocacy file, please provide the following information.
1. Describe student's medical history and prognosis. What is student's current health status? Is your physician an ally and a strong advocate for your child?
2. Describe student's educational profile. What was student's level of performance, attendance and achievement before illness or injury? What are student's current educational and health management challenges?
3. What is the impact of student's condition on activities of daily living? school attendance? achievement? grades?
4. What is the impact of student's symptoms or condition on social relationships at school and in the community?
5. What is the impact of student's symptoms or condition on participation in extra curricular activities?
6. What is student's credit status?
7. What is the school climate? What are the attitudes of school officials or staff?
8. What policies and practices have been a help? a hindrance?
9. Is your child healthy at home but gets sick at school?
10. What is the current plan? Do you have an Individualized Education Plan, Individualized Health Plan or S. 504 Accommodation plan?
11. Has the school district given you the official booklet or document describing your child's rights under federal and state anti-discrimination laws and special education laws?
12. Who are your allies at school? in the community? Do you belong to a support group?
13. What other information do you think is significant or necessary for understanding your child's needs?
14. What would you like to see happen at school that is not happening now?
15. What would you like to stop happening at school?
16. Do you believe that your child is safe at school? If not, why not?
ELLIE GOLDBERG, M.Ed. is an education and environmental health advocate for healthy children, safe schools and sustainable communities – clean water, clean air, clean energy and safe food. Inspired by the legacy of Rachel Carson, who taught that our health and security is intimately connected to the quality of our environment, Ellie is active in public health, environmental, educational and public policy organizations working to increase citizen engagement, government accountability and corporate responsibility on behalf of children and their healthy development.