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Nebraska
College of Education and Human Sciences
Nebraska Deafblind Project
Nebraska Deaf-Blind Summer Institute Registration Form
Nebraska Deaf-Blind Summer Institute Registration Form
Nebraska Deaf-Blind Summer Institute
July 18-19, 2022 | Nebraska East Union
Registration is due June 30, 2022.
Name (first and last)
Required
Position/Title
Required
Deaf Educator
Teacher of the Visually Impaired
Orientation & Mobility Specialist
Special Education/Resource Teacher
General Education/Classroom Teacher
School Psychologist
Speech-Language Pathologist
Occupational Therapist
Physical Therapist
Paraeducator
Sign Language Interpreter
Assistive Technology Specialist
Service Agency Representative
Administrator
Parent
Other
Other - please explain
Required
School District/ESU/Agency
Required
City
Required
State
Required
Zip Code
Required
Preferred Email (summer)
Required
You will receive additional information by email, so be sure to check this address periodically.
Preferred Phone Number (summer)
Required
Please include the area code.
I plan to attend:
Required
In-Person
Via Zoom
I plan to attend:
Required
July 18
July 19
Both Days
Accommodations Needed (please describe)
Comments
Leave this field blank