Nebraska Regional Programs Pen Pals

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Interested in becoming a pen pal with another student who is Deaf or hard of hearing from Nebraska? If so, please complete this form in order to be matched with a pen pal.

Name of Student (First & Last) *

Age *

Grade (2021-2022) *

Student's email *

Type N/A if student does not have an email address.

Student's address (including city and zip code) *

Student's phone number *

Type N/A if student does not have a phone number.

Which of the following would you like SNRP to share with your assigned pen pal? *

Check all that apply. If you do not wish to have your contact information (email, address, phone number) shared with your assigned pen pal, SNRP would be happy to send communication to your pen pal for you or facilitate chats.

student's email address

student's mailing address

student's phone number

None of the above. I would prefer SNRP to help facilitate pen pal correspondence.

Required

Additional Information *

Please share any additional information about yourself/your child including interests that would be helpful for SNRP to know in order to pair you with a pen pal.

I give permission for my child to participate in the pen pal program. I understand that only the information that I indicated above will be shared with my child's assigned pen pal.

Parent's email address *

Parent Signature *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Lincoln Public Schools. Report Abuse

Forms