Intervention Request

Member Intervention Forms

Please, select an option from the drop down below and fill out the subsequent form to help us better understand your problem and facilitate you better.

What are you having an issue with?*
I acknowledge that in order to home school legally in Texas, I must provide bona fide instruction with a visual curriculum that includes the basic subjects of reading, spelling, grammar, mathematics, and good citizenship for my student(s).*
Note: SSA will ask clients to fill out form SSA-1372 (7 pages and available for them to download at www.SSA.gov). This is completely normal, and we encourage members to fill out the form as it is often required for benefits to process normally. SSA typically mails SSA-1372-BK to child three months before their eighteenth birthday, or child obtains an SSA-1372-BK from his or her local Social Security office, or child downloads and prints the SSA-1372-BK.
I acknowledge that I have submitted my SSA-1372 and confirmed receipt.*
- Yes
- No
THSC can not successfully intervene until you have filed your SSA-1372. Additionally, if you have filed this form in the past, and had your benefits extended, but have now received a new notice about your benefits, SSA will likely require a new SSA-1372 for this case.
The attorney will consult with you, about your questions related to the homeschool issue involved in the custody case. After the consultation, the attorney will have forms for you to fill out to help organize information for your case. By initiating a custody intervention, you agree that you will complete the forms requested by the attorney. The attorney will send them to you and ask for you to either create a gmail or use one for this purpose that you might already have (forms are in Google Doc format).

After completing the forms, the attorney will be available to visit with you about the information provided. The attorney needs these forms to help you create a plan to share with the your court attorney who will then have more information to present in a hearing or mediation.

The forms sent by the THSC custody attorney will be needed to help them focus on what is most needed to help you.
General Information
Deadline
Deadline:
(Letters typically require seven business days to complete)
Deadline:
(Letters typically require three business days to complete)
Your Name:*
First Last
Spouse's Name (if married):
First Last
Are you a THSC Member?*
If you do not have a membership with THSC, please contact Customer Support at staff@thsc.org.
THSC Account ID*
Membership Expiration:
MM
DD
YYYY
Name on THSC Account:
First Last
Gender of Primary Member:
Email*
Phone*
Member Address*
Street Address City State ZIP Code
Is this a PO Box Address?*
Please provide physical street address*
Street Address Address Line 2 City State ZIP Code
CPS Information
Date of Initial CPS Contact:*
CPS Caseworker Name:
(If Available)
First Last
Caseworker Contact Info:
(If Available)
Please attach any related documentation from CPS
Drop files here or
Details for CPS attorney:
Custody Information
Has suit affecting parent/child relationship been filed?*
Date of Filling:
County:
Name of Non-Custodial Parent:*
Attorney General Case Number:*
Cause Number:*
Court Number:
Judge Assigned:
Type of Case:
(Divorce, Suit Affecting Parent Child Relationship, Modification, etc..)
Do you have your own attorney for this issue?
Attorney's Name:
First Last
Attorney's Phone:
Attorney's Email
Attorney's Address:
Street Address City State ZIP Code
Next Court Hearing Date:
Type/Name of Hearing:
Have you been served discovery?*
Date Discovery Was Served
Why is homeschooling an issue in this case?*
(What has opposing party alleged to bring the issue of homeschooling to the court system?)
What three questions do you want an attorney from our organization to answer during your consultation?
Other Details for Consultation Attorney:
*If the divorce decree states that the child/children must receive education from an “accredited” program or if it prohibits them from homeschooling, please let us know. If the decree states the program must be “accredited” or prohibits you from homeschooling, then our intervention letter may do more harm than good. If you are not sure, then please upload copies of that part of the divorce decree attached and we will review prior to taking action.*
Note: Divorces after September 1, 2003 fall under see HB 944. For divorces prior to September 1, 2003, HB 944 was not in affect. See the article: Home Schooling and Child Custody/
Student Information
How many children are involved?*
Student's Name:*
First Last
(Please, verify spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Second Student
Student's Name:*
First Last
(Verify Spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Third Student
Student's Name:*
First Last
(Verify Spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Forth Student
Student's Name:*
First Last
(Verify Spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Fifth Student
Student's Name:*
First Last
(Verify Spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Sixth Student
Student's Name:*
First Last
(Verify Spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Current Grade for Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
For more than six students, please place their information below:*
Student's Name:*
First Last
(Please, verify spelling)
Student's Gender:*
Student's Birthdate*
Student Age:*
Student Social Security Number (SSN):*
Sponsor Social Security Number (SSN):*
All data for a family is listed under the sponsor’s number (not the student)
Claim/Case Number:*
Current Grade Year of Student:*
(First Grade, Sixth Grade, Highschool Freshman, etc.)
Current Grade Year of Student:*
(Eleventh grade, highschool senior, college freshman, etc.)
Expected Graduation Date:*
MM
DD
YYYY

(To the Exact Day)
Number of Hours Per Week for Classwork:*
Current list of Courses:*
Veteran Affairs Information
Name/Phone Number of Case Worker:*
Name of Supervisor:
First Last
Date of Original Notice:
Date of Latest Notice:
Address of Local VA Office:
Street Address Address Line 2 City State ZIP Code
Higher Education Institution Information
Name of School / College / University:*
School / College / University Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School / College / University Email:
School / College / University Phone:
Name and Title of School Official / Admissions Clerk / Registrar Official:
Mailing Information
Where should the letter be mailed to?
(If required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Member Address*
Street Address Address Line 2 City State ZIP Code
Where should the letter be emailed to?
(If required)
What happened causing you to require a member verification?*
(Include information on how and when we were contacted regarding the issue)
School and Withdrawal Information
State the Problem or Issue:
(Include information on how and when you were contacted regarding the issue)
Name and position of School Official:
(if applicable)
Date Withdrawn:
(if applicable)
Method used to withdraw your student:*
(select all that apply)
Was your withdrawal acknowledged by the school?*
Date the School Acknowledged:
Did the school have you sign a form?*
Do you have a copy of the form?*
Please upload the form for THSC to review
How did the school contact you?*
(select all that apply)
Does your child have any absences prior to the withdrawal?*
Please Explain the Absences:
Did you return all school-owned supplies?*
Did you obtain any school records for your student?*
Other Homeschooling Information
How long have you been homeschooling?*
What does a typical day in your homeschool look like?*
Are you a member of a homeschool support group?*
Name of Homeschool Support Group:
Are you involved in other groups that could serve as a reference?*
Names of Other Groups:
Do you know the five requirements of education according to Texas law?*
- Yes
- No
Social Security Information
Student Social Security Number:*
Claim/Case Number*
Name/Phone Number of Case Worker:*
Name of Case Worker's Supervisor:
Is this a new request for benefits or a benefit termination notice?*
Please provide date you submitted your request for benefits:*
MM
DD
YYYY
Please indicate what response you received from SSA:*
Did you receive a letter from Social Security Administration stating benefits would be ending?*
Please enter the letter date of the first termination notice that you received:*
MM
DD
YYYY
Please describe the reason a letter has not been sent out in the box below*
(Example: You know the benefits are getting ready to expire and want to get started on extending benefits)
Please enter the letter date of the latest termination notice that you received:
MM
DD
YYYY
Are you still receiving benefits?*
Date Last Payment Received*
Address of Local SSA Office:*
Street Address Address Line 2 City State ZIP Code
Leave This For Form to Function
Where Should the Letter be Mailed to?
(If Required)

Street Address Address Line 2 City State ZIP Code
Where Should the Email be Sent to?

(If Required)
Please Note: THSC will mail your letter to the following address unless we are instructed otherwise by you.
Texas OAG, Central File Maintenance, P.O. Box 12048, Austin, TX 78711-2048
If mailing address is different, please provide contact name and mailing address for alternate address:
Street Address Address Line 2 City State ZIP Code
Ending Info
State the Problem/Issue:
Current Status of Your VA Benefits:
Current Status Related to Your SSA Benefits:
Please note that the SSA Privacy Release is not a THSC form, but is a form from SSA.gov, required by SSA for us to help you with your claim. You MUST download the form, print, and physically sign, and then send the copy of the signed, completed form back to THSC.
Privacy Release: In order to intervene on your behalf, THSC frequently finds that we must have a signed privacy release. Please provide the name(s) of the organization(s) that we need to contact in the appropriate place on the form so that your request is not delayed due to this missing information. Be sure to provide any applicable case or reference number(s) that we will need to provide to the organization.
SSA Consent for Release of Information form.
In order for the SSA office to accept our assistance, which is to confirm that your homeschool meets state requirements, the following information is needed on the SSA Consent for Release of Information Form:
1. Please be sure to check 1 - 4 on the form
2. The privacy release should authorize the following people by listing in the section that reads: Name of Person or Organization
3. Please use the following address in the section that reads: Address of Person or Organization (for the above listed names). Please use the THSC address for all contacts:
Submit SSA Curriculum Affidavit
(SSA Curriculum Affidavit must be received to begin your SSA Intervention Letter.
Please Download, Fill Out, Sign, and Attach both the SSA consent release and the SSA Curriculum Affidavit)
If needed, you can email, fax, or mail these forms to us at:
Email: Staff@thsc.org
Fax: 806-744-4446
Mail: THSC, Attn: Customer Relations IL Requests, PO Box 6747, Lubbock, TX 79493
Synopsis of Situation:*
Current Status with Attorney General:*
(payments not being received, or still being received, etc.)
Applicable links to websites:

(please, separate all links with a new line)
Work Permit Mailing Information
Please Note: THSC emails the work permit letter to the member. We will address the work permit letter to the following address unless we are instructed otherwise by the member.
Department of Industrial Relations
Division of Labor Standards Enforcement (DLSE)
ATTN: Entertainment Work Permit Section
6150 Van Nuys Boulevard, Room 100
Van Nuys, CA 91401
Please Note: THSC emails the work permit letter to the member. We will address the work permit letter to the following address unless we are instructed otherwise by the requester.
Att: New York Department of Labor
Division of Labor Standards
Permit and Certificate Unit, Room 266A
State Office Campus, Building 12
Albany, NY 12240
Alternative Address:
(If applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Any amplifying information we should know related to this letter:
The THSC letter should be used to accompany documentation you are required to submit for the work permit.
Privacy Release Info
Privacy Release: In order to intervene on your behalf, THSC frequently finds that we must have a signed privacy release. Please provide the name(s) of the organization(s) that we need to contact in the appropriate place on the form so that your request is not delayed due to this missing information. Be sure to provide any applicable case or reference number(s) that we will need to provide to the organization.
Download, sign, and attach the privacy release.
Upload any pertinent documentation:
Drop files here or
Comments
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Member Intervention Forms

General Information

CPS Information

Custody Information

Student Information

Second Student

Third Student

Forth Student

Fifth Student

Sixth Student

Veteran Affairs Information

Higher Education Institution Information

Mailing Information

School and Withdrawal Information

Other Homeschooling Information

Social Security Information

Leave This For Form to Function

Ending Info

Work Permit Mailing Information

Privacy Release Info