SD Supporting Families Community of Practice
Regional Meeting
Sturgis
Area
When: Wednesday June 12th Time: 5:30-7:30 PM MT
Location: Sturgis Community Center
1401 Lazelle Street, Sturgis, SD 57785
1.
Name
2.
Role in attending
Self-Advocate
Family Member
Family/Professional
Community Partner/Professional
3.
Self-Advocates and Family Members will receive a stipend for attending. Please list your mailing address and email address below:
4.
Which of the following options most closely aligns with your gender?
Woman
Man
Prefer not to answer
5.
What is your race or ethnicity?
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Multiracial or Multiethnic
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
Self-describe below:
6.
Are there any special accommodations needed?
7.
Email Address
