Parent Leadership & Advocacy Conference 2020 13th Annual Traveling Mini-Conference for parents, professionals and community members; serving infants, children and youth at risk of, or with disabilities. OK Question Title * 1. Choose your Island of residence. Hilo Kauai Lanai Maui Molokai Oahu OK Question Title * 2. Please complete the following: Name Company Address Address 2 City/Town State ZIP Country Email Address Phone Number: Work/Cell/Home OK Question Title * 3. Please select your role as a conference participant. I am a . . . Parent/Guardian of a child with a disability Parent/Guardian Surrogate Parent Professional (Skip to question 7) Grandparent/Family Member of a child with a disability Student (Skip to question 7) OK Question Title * 4. If you are a parent of a child with a disability, please answer questions 4-5. All others please skip to question 7.Choose the appropriate box below that represents your child with a disability Gender Age Child 1 Male Female Child 1 Gender menu Age 0-2 Age 3-5 Age 6-8 Age 9-12 Age 13-15 Age 16-18 Age 19 and above Child 1 Age menu Child 2 Male Female Child 2 Gender menu Age 0-2 Age 3-5 Age 6-8 Age 9-12 Age 13-15 Age 16-18 Age 19 and above Child 2 Age menu Child 3 Male Female Child 3 Gender menu Age 0-2 Age 3-5 Age 6-8 Age 9-12 Age 13-15 Age 16-18 Age 19 and above Child 3 Age menu OK Question Title * 5. Please describe your child's disability. Child's Disability Child 1 Autism Spectrum Disorder Deaf/Blindness Deaf-Hearing Disability Developmental Delay Emotional Disability Intellectual Disability Multiple Disability Orthopedic Disability Other Health Disability Specific Learning Disability Speech or Language Disability Traumatic Brain Injury Visual Impairment including Blindness Child 1 Child's Disability menu Child 2 Autism Spectrum Disorder Deaf/Blindness Deaf-Hearing Disability Developmental Delay Emotional Disability Intellectual Disability Multiple Disability Orthopedic Disability Other Health Disability Specific Learning Disability Speech or Language Disability Traumatic Brain Injury Visual Impairment including Blindness Child 2 Child's Disability menu Child 3 Autism Spectrum Disorder Deaf/Blindness Deaf-Hearing Disability Developmental Delay Emotional Disability Intellectual Disability Multiple Disability Orthopedic Disability Other Health Disability Specific Learning Disability Speech or Language Disability Traumatic Brain Injury Visual Impairment including Blindness Child 3 Child's Disability menu OK Question Title * 6. Please describe your child's race/ethnicity. African American Asian Caucasian Filipino Hispanic Hawaiian/Part Hawaiian Pacific Islander Other (specify) OK Question Title * 7. As a professional/community member, I am attending the conference in which capacity? Please select the best option. Administrator/Manager Teacher/Tutor Vendor-Exhibitor Provider- i.e., early childhood, behavior health, Part B - IDEA, Attorney, Doctor Community Member-i.e., friends of the disability community Student Other (please specify) OK Question Title * 8. Have you attended a training presentation from us in the past 12 months? Yes No OK Question Title * 9. Please select one presentation from Breakout Session 1:20 - 2:20p.m. Speaker: Jeremy & Terra DanielTopic: Our Story: Triumphs & Tragedy Speaker: Barbara Fischlowitz-Leong (ATRC)Topic: Alternate Ways to Tell the Story Speaker: Dr. Rhonda Black (UH-Manoa)Topic: Student-Directed IEPS: Telling Your Story, Sharing Your Dream OK Question Title * 10. Please select one presentation from Breakout Session 2:30 - 3:30p.m. This breakout has two speakers that will be sharing the time.Speaker: Melissa CastilloTopic: My Story: The Struggle is RealSpeakers: Chase & Regina CornielTopic: Parent Partners in Advocacy Speaker: Margaret Higa (HIDA)Topic: Building Academic & Other Critical Skills for Lifelong Success: Children with Dyslexia/SLD Struggle In/Out of the Classroom This breakout has two speakers that will be sharing the time.Speakers: Jordan Ilae & Ian NieblasTopic: Transition from High School to AdulthoodSpeaker: Renee ManfrediTopic: This is Me OK Question Title * 11. Special Needs:LDAH fully intends to comply with the legal requirements of the Americans with Disabilities Act. If you are in need of accommodation, please give us two weeks notice prior to the activity will help us serve you better. I don't need accommodation I need accommodation OK DONE
