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Parent-to-Parent Listening & Learning Training Registration
The Federation for Children with Special Needs is funded by grants which require us to collect data. Our registration is confidential and used to ensure we are supporting all communities. We do not share personal information nor do we sell to third parties.
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* Indicates required question
Email
*
Your email
Choose training date.
*
Monday, October 16, 2023 6-8pm
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
Massachusetts
Other:
Clear selection
Zip/Postal Code
*
Your answer
Phone
*
Your answer
Organization
Your answer
Are you attending this event as a:
*
Parent/Caregiver
Foster Parent
Grandparent
Student (14-22)
Professional/Educator (including teachers, teachers, aide and all support services provided in a public, charter and 766 schools)
Professional/Other
Special Education Decision Maker (SESP)
Required
Primary Language
*
English
Chinese
Haitian Creole
Portuguese
Spanish
Vietnamese
American Sign Language
Other:
Do you need interpretation in order to participate in the training?
We kindly ask that you register at least 14 days in advance if your access needs include interpretation in order for us to secure an interpreter for your language of choice.
*
Yes
No
Other:
Required
Which gender identity do you identify as?
*
Man
Woman
Nonbinary
I prefer not to answer
Other:
Are you Hispanic/Latino?
*
Yes
No
What is your race?
*
Caucasian/White
African American/Black
American Indian/Native American/Alaskan Native (*Specify below)
Asian
Native Hawaiian/Pacific Islander (*Specify below)
Two or more races
Undisclosed
Other:
*Specify Race
Your answer
Ethnicity
*
African (*specify country below)
African American
Albanian
American
Armenian
Brazilian
Cambodian/Khmer
Canadian
Cape Verdean
Caribbean Islander (*specify island below)
Chinese
Colombian
Cuban
Dominican
English
Filipino
French
German
Greek
Guatemalan
Haitian
Indian /Asian Indian
Irish
Italian
Japanese
Korean
Laotian
Mexican, Mexican American, Chicano
Middle Eastern (*specify country)
Native American
Polish
Portuguese
Puerto Rican
Russian
Salvadoran
Scottish
Swedish
Ukrainian
Vietnamese
Unknown
Undisclosed
Other:
*Specify Country or Island
Your answer
How old is your child with special needs?
Birth to 3
3-5
6-11
12-13
14 - Graduation
Beyond High School Graduation or Aged Out
Undisclosed
Not Applicable Attending as a Professional
Clear selection
What is your child's primary disability?
*
Autism
Deaf Blindness
Deaf
Developmental delay (3-9)
Emotional Disturbance
Hearing Impairment
Intellectual Disability
Orthopedic Impairment (physical)
Other Health Impairment (ADD/ADHD)
Specific Learning Disability (Dyslexia, Non-Verbal Learning Disorder)
Speech or Language Impairment
Visual Impairment - Blindness
Inappropriately identified due to lack of good instruction, environmental or economic factors, or limited English proficiency
Disability is suspected or not yet identified
Not disclosed
Not Applicable/Attending as a Professional
What is your child's secondary disability (if applicable)?
Autism
Deaf Blindness
Deaf
Developmental delay (3-9)
Emotional Disturbance
Hearing Impairment
Intellectual Disability
Orthopedic Impairment (physical)
Other Health Impairment (ADD/ADHD)
Specific Learning Disability (Dyslexia, Non-Verbal Learning Disorder)
Speech or Language Impairment
Visual Impairment - Blindness
Clear selection
What is the highest level of education that you have completed?
Less than high school
Some high school
High school
Some college
College undergraduate degree (Associates, Bachelors)
College graduate degree (Masters, Doctorate)
Prefer not to say
Clear selection
How many family members are in your household?
1
2
3
4
5
6 or more
Clear selection
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