OCDBE Census Referral Form for Individuals with Deafblindness
Welcome to the Ohio Census of Individuals with Combined Hearing & Vision Losses
This form exists for the purpose of registering individuals on the statewide deafblind census, which is conducted by The Ohio Center for Deafblind Education (OCDBE). Individuals being registered should be from birth through 21 years of age and have combined hearing and vision losses. It should be noted that an individual does not need to be completely deaf and totally blind to be considered deafblind. In fact, most people with deafblindness have some usable hearing and some usable vision.
In accurately identifying children as deafblind, you are unlocking a better understanding of their unique needs, and by registering those children, you are granting access to free services and supports for them, as well as for their families and support teams.
We are glad you are here, and look forward to being of service in any way we can.
Any person can register an individual an any time. If you know of more than one individual who is eligible to be registered, please complete a separate form for each. Prior consent to disclose information is not required. We do ask, however, that if you are not the parent of the individual, you make the family aware that you are registering their child and request their permission to share their information with us. The more complete the information you provide here, the more targeted and appropriate the services and resources we can provide.
Questions concerning this form should be directed to the Census Coordinator, Allison Glasgow, by email at censuscoordinator@ssco.org or by phone at 800.229.0844 ext. 109. For additional details concerning the deafblind census and for general information regarding the OCDBE project, please visit us on the web at www.ssco.org/ocdbe. Thank you for your time and attention.
*note* Throughout this form, the person you are registering will be referred to as "the individual."