Secure Partner Portal

School District Referral Portal

Parent Counseling & Training Services

Thank you for partnering with Citywide Therapy & Consulting. Please complete the secure referral form below to request Parent Counseling & Training services. Upload the student's current IEP and any supporting documentation. A representative will review your referral and contact you within two business days.

Submit Referral

Privacy Notice: Educational records submitted through this portal are handled confidentially and used solely to coordinate the requested services. All data is transmitted over a secure HTTPS connection and stored with restricted access in compliance with FERPA.

District Information

District Name *

School Building *

Referring Staff Member *

Title *

Email Address *

Telephone Number *

CSE Chairperson (optional)

Student Information

Student Name *

Date of Birth *

Grade *

Student ID (optional)

Primary Disability

School Program

Preferred Language

Interpreter Needed

Parent Information

Parent Name *

Telephone *

Preferred Language

Requested Service

IEP Service Information

Frequency

Session Duration

Delivery Method

Extended School Year

Service Start Date

Service End Date

Student Needs

Upload Documents

Accepted: PDF, DOC, DOCX, JPG, PNG — max 25 MB per file. Multiple files allowed.

Click to upload documents

Current IEP, Evaluations, BIP, Progress Reports, Other

Additional Notes

* I certify that I am authorized by my school district to submit this referral and securely transmit educational records for the purpose of initiating Parent Counseling & Training services.

All information is transmitted securely over HTTPS and stored with restricted access.