Step by Step Academy

Please fill out the form below. A Step By Step Academy associate will contact you shortly.

Reason for contacting us*
Child's Name *
Parent/Guardian Name *
Childs's Date of Birth *
Address *
City *
State (postal code) *
Zip *
County of Residence *
Home Phone Number *
Work/Daytime Phone Number *
Email Address
Home Consultant?
If yes, Name of Consultant
Home School District
Your Child's current funding resources (check all that apply): * This is for informational purposes to help Step By Step identify possible service options available to your child.	Medicaid Card Caresource Card Level I Waiver IO Waiver Autism Scholarship Program Transition Waiver Home Health Waiver
Has your child been diagnosed with a genetic disorder, medical condition, autism, mental retardation, or any mental health or behavior problem? *	List answer and diagnosis here
How did you hear about our services? Check all that apply: *	Friend Step By Step News Publication SBSA Web site Physician/Pediatrician Step By Step Academy Mailing County Board of MRDD School District Internet (web search, links, etc.) Other
Message (optional):	Type any additional comments or questions here.
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