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* 1. How much do you know about the Deaf Community and Deaf Culture? 

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* 2. How much do you know about American Sign Language (ASL)

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* 3. What is the biggest challenge your family experiences with your child with a hearing loss?

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* 4. What type of communication do you use with your child with a hearing loss at home?

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* 5. If there are siblings in the home, what types of communication does the sibling(s) use with your child with a hearing loss?

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* 6. What type of schooling does your child experience?

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* 7. Are you satisfied with your child's IEP?

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* 8. Would you like assistance and/or support in participating in your child's IEP meetings and process?

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* 9. Has your family been able to access equipment and learning tools needed for this school year?

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* 10. Do you have access to WiFi in your home?

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* 11. Does your child with a hearing loss have access to additional supports in school (interpreting, note taker, etc)

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* 12. What types of supports does your child receive? Please mark all that apply

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* 13. Would you be interested in having a Deaf Mentor work with your family?

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* 14. Would you be interested in having a Deaf or Hard of Hearing Mentor assist your child with a hearing loss with school/homework?

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* 15. Would you be interested in receiving more information about these and other topics?

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* 16. What county do you live in?

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* 17. What are the age(s) of child(ren) with hearing loss living in your home?

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* 18. Please provide your contact information (optional)

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