You are interested in one of our Educational Programs at the Santa Clara County Office of Education and you want someone to contact you with additional information.
Please make sure to fill out this section completely.
Click here to find a provider in your area.
Please complete this section if Secondary Parent is related by Blood, Marriage, Adoption or Foster.
If you receive any government aid such as TANF, Cash Aid, or SSI you are eligible for our services. If you do not receive government aid please add your annual gross income before taxes.
In child notes please include if your child has an active Individualized Educational Plan (IEP) or Individualized Family Service Plan (IFSP).
- Your Address - Available Locations
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Are there other children in the family?

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Required information is missing, see above.