Log In Issue - Web Support Request Form for ParentCheckin.com and ReferralCheckin.com

This form allows you to submit a technical support request or request a change in your email address on record. This form is for parents or referral sources who already have a child enrolled in an Aspen program. If you are still considering a school or program and would like assistance, please fill out an admissions contact form. If you have a question about your enrolled child's therapy, academics, or other personal information, please do not use this form. Please contact the program directly where your child is enrolled.

Because the information you are accessing is extremely confidential, for security reasons we may need to contact you to confirm any changes. Please read this form carefully to avoid confusion. If you are changing your email address, we will need your OLD address and new address to help us verify this change. We cannot process incomplete forms.
Your First Name *
Your Last Name *
I am a Parent Referring Professional (Please check one) *
Your CURRENT email address on record * (this is where we will email you about this request)
If applicable, your NEW e-mail (only if you are changing your email address)
CONFIRM NEW e-mail
Your address *
city *
state *
zip *
Your Phone *

If you are a Referring Professional, please list the program that most recently sent you an email notice that you have been given access to a student you referred : *

If you are a Parent, please list the SCHOOL OR PROGRAM your child is attending: *

If you have a specific issue, please describe here. It is important to give as much detail as you can about the issue you experienced to help us serve you more quickly: