Copy of Project Independence/Proyecto Independencia (Fall 2020)

Youth ages 14 -21 and their Parents: What Happens After High School

One workshop for youth and one workshop for parents.

6:00 - Youth workshop

6:30 - Parent workshop

Spanish Interpreter Available/
Intérprete de español disponible

Question Title

* 1. Registration Form/Formulario de inscripción

First Parent Name/Nombre

Second Parent Name /Nombre

Address/Dirección

Address 2/Dirección 2

City/Town/Ciudad

State/Province/Estado

ZIP/Postal Code/ Código Postal

Email Address/Dirección de Correo Electrónica

Email Address 2/Dirección de Correo Electrónica 2

Phone Number/Número de Teléfono

Question Title

* 2. Do you have dietary or accommodation needs?/¿Tiene Usted necesidades
dietéticas o de acomodacíon?

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* 3. Describe your need:/¿Describe su necesidad?

Place need here

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* 4. Please describe your race/ethnicity./¿Por Favor de describir su raza/orgen
étnico?

American Indian/Native American/Alaska Native

Asian

Black/African American

Caucasian

Native Hawaiian/Other Pacific Islander

Hispanic/Latino

Two or more races

Other (please specify)

Question Title

* 5. What is your child's disability?/¿Cuál es la discapacidad de su hijo/a?

ADD-ADHD

Autism Spectrum Disorder

Deaf-Blindness

Developmental Delay (EC)

Emotional Disturbance

Gifted

Hearing Imp. (include Deafness)

Intellectual Disability

No IDEA Disability

Orthopedic Impairment (Physical)

Other Health Impairment

Specific Learning Disability

Speech/Language Impairment

Suspected/Undiagnosed

Visual Impairment (include blindness)

Other (please specify)

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* 6. How do you know about THRIVE Center?/ ¿Cómo sabe sobre el Centro de
THRIVE?

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* 7. Will you need Spanish translation?/¿Necesitarás traducción al español?

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* 8. How old is your child?/¿Cuántos años tiene su niño/a?

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* 9. First and last name of your child

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* 10. First and last name of child #2

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* 11. Do you receive services from a community centered board?
¿Recibe servicios de una junta centrada en la comunidad? (Ex. Rocky Mountain Human Services, Developmental Pathways, Developmental Disabilities Resource Center, etc...)

Yes/ Si

Not sure/
No estoy seguro

Question Title

* 12. If yes, please check which one.
En caso afirmativo, compruebe cuál.

Rocky Mountain Human Services

Developmental Pathways

Developmental Disabilities Resource Center

North Metro Community Services

Imagine

Question Title

* 1. Registration Form/Formulario de inscripción

Question Title

* 2. Do you have dietary or accommodation needs?/¿Tiene Usted necesidades dietéticas o de acomodacíon?

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* 3. Describe your need:/¿Describe su necesidad?

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* 4. Please describe your race/ethnicity./¿Por Favor de describir su raza/orgen étnico?

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* 5. What is your child's disability?/¿Cuál es la discapacidad de su hijo/a?

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* 6. How do you know about THRIVE Center?/ ¿Cómo sabe sobre el Centro de THRIVE?

Question Title

* 7. Will you need Spanish translation?/¿Necesitarás traducción al español?

Question Title

* 8. How old is your child?/¿Cuántos años tiene su niño/a?

Question Title

* 9. First and last name of your child

Question Title

* 10. First and last name of child #2

Question Title

* 11. Do you receive services from a community centered board? ¿Recibe servicios de una junta centrada en la comunidad? (Ex. Rocky Mountain Human Services, Developmental Pathways, Developmental Disabilities Resource Center, etc...)

Question Title

* 12. If yes, please check which one. En caso afirmativo, compruebe cuál.

* 2. Do you have dietary or accommodation needs?/¿Tiene Usted necesidades
dietéticas o de acomodacíon?

* 4. Please describe your race/ethnicity./¿Por Favor de describir su raza/orgen
étnico?

* 6. How do you know about THRIVE Center?/ ¿Cómo sabe sobre el Centro de
THRIVE?

* 11. Do you receive services from a community centered board?
¿Recibe servicios de una junta centrada en la comunidad? (Ex. Rocky Mountain Human Services, Developmental Pathways, Developmental Disabilities Resource Center, etc...)

* 12. If yes, please check which one.
En caso afirmativo, compruebe cuál.