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NEC Parent Luncheon Kickoff
Event Timing: May 3, 2019
Event time: 10:00am to 2:00pm
Event Address: 50 Beechwood Ave. Watertown, MA (Grousbeck building, Room N103)
Contact us at 617-972-7515 or
nec@perkins.org
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The New England Consortium for Deafblind Technical Assistance (NEC)
Full Name
*
Your answer
Email
*
Your answer
My PERSONAL Connection to is...(select one)
*
Parent
Sibling
Grandparent
Spouse or Significant Other
Foster Parent
Friend
Guardian (non-family)
None
Required
My PROFESSIONAL Connection to is...(select one)
*
Health Care Professional
Case manager or Support Coordinator
Educator (Teacher or Administrator)
Disability or Aging Service Provider
Direct Support Professional
Employment Professional
Person Centered Plan Facilitor
Self-Advocate or Family Leader
College Student
None
Other:
Required
City
*
Your answer
State
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Choose
CT
ME
MA
NH
VT
Day Phone
Your answer
Add me to The NEC Family Learning Series Mailing List.
*
Yes
No
Required
Is your child register with NEC or child at risk with combine vision & hearing loss?
*
Yes
No
Required
Will you need an interpreter?
Yes
No
Please tell us about yourself and why you would like to participate in the program.
*
Your answer
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