CSB Short Course Interest Form 2023-2024
At this time, our organization is currently not offering any short courses but is interested in connecting with families and teams who may be interested in a week-long individual short course where an outreach student joins a CSB classroom either as a day or residential student for a week. If you are interested please fill out this form. 
Sign in to Google to save your progress. Learn more
Student's Name *
Age *
Gender *
Name of Parent/Guardian *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Name of School District or County of Education *
Name of Teacher of Visually Impaired Students (TVI) *
TVI Phone Number *
TVI Email *
Name of Orientation and Mobility Specialist (O&M) 
O&M Phone Number 
O&M Email
Name of Person who Completed the Form
 *
Email Address of Person who Completed the Form
 *
Please express your thoughts on the potential benefits of a customized short course for your student during this academic year and any specifics we should take into consideration in planning.
How did you hear about our Short Courses?
*
Questions/Comments
Please be on the lookout for our posting of Summer Academies in June of 2024 soon! For questions about the courses please contact Gaonu Vue, Outreach Coordinator, at gvue@csb-cde.ca.gov or by phone at 510-936-5506. See the Short Course Program Frequently Asked Questions for more information.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of California School for the Blind. Report Abuse
Google Forms