Family Consulting Application

To start your family consulting engagement, please complete the below application and submit your $50 deposit.

Once we’ve received your application and payment, we’ll contact you to begin the next step in the process.

If you have any questions as you complete the application, please contact Director of Education Emily Lourim at emily@onmyownofmi.org or (248) 649-3739 x 221.

Family Consulting Application

Step 1 of 3

Applying For:
Student First + Last Name*
Student Date of Birth*
MM slash DD slash YYYY
Student Gender Identity*
Student Pronouns*
Student Grade Level*
Student School Name:
Student Developmental Disability*
Does Student Currently Have an IEP, 504 Plan or Annual Plan?*
- Yes
- No

Parent / Guardian #1 First + Last Name*
Parent / Guardian #1 Relationship to Student*
Parent/Guardian #1 Address*
Street Address Address Line 2 City State ZIP
Parent/Guardian #1 Email Address*
Parent/Guardian #1 Cell Phone Number*
Parent / Guardian #2 First + Last Name
Parent / Guardian #2 Relationship to Student
Parent/Guardian #2 Address
Street Address Address Line 2 City State ZIP
Parent/Guardian #2 Email Address
Parent/Guardian #2 Cell Phone Number

Make $50 Deposit