WSDS SCHOLARSHIP APPLICATION
2021-2022 school year

Please answer the following as best as you can. Note:  All applications will be considered and further paperwork, including letters of recommendation may be requested:

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* 1. Name

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* 2. School District

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* 3. Current Position

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* 4. Email:

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* 5. How many years have you worked with children in Special Education?

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* 6. For the 2021-2022 school year, will you be working with a student with deafblindness? (e.g. has a vision loss and is deaf or hard of hearing, which may be in addition to other disabilities.)

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* 7. Do you have experience with children or youth who are blind or visually impaired?

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* 8. Do you have sign language skills (American Sign Language, Signing Exact English)

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* 9. Do you have experience with assistive listening devices, such as hearing aids, FM/DM systems and/or cochlear implants?

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* 10. Have you participated in the WA Cohort of Open Hands, Open Access (OHOA) Deafblind Modules and/or Deafblind Summer Institute Leavenworth) ?

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* 11. If you have participated in OHOA or the DB Summer Institute, what strategies have you taken away?

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* 12. Have you discussed the CMU Program with your Supervisor/District Administrator?

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* 13. Why are you interested in becoming an Intervener?

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