Parent Ed- Assistive Technology (11-8-16) Question Title * Please provide your contact information Name: Address 1: City/Town: State/Province: ZIP/Postal Code: Email Address: Phone Number: Question Title * Please indicate your primary language: English Spanish Other (please specify) Question Title * How do you identify your ethnicity/race? Please circle all that apply: American Indian or Alaskan Native Asian White Black or African American Hispanic/Latino Native Hawaiian or Pacific Islander Prefer not to answer Other (please specify) Question Title * Are you a: Parent Professional Question Title * Parent and guardians, what is your youth's age? Question Title * What is your child's special need(s)? Done