Student Information

Thank you for registering a student for addition to the GSAP Child Count of Students with Combined Vision and Hearing Loss.  When we receive this form, we will add the student to our secure database and contact the person designated below to complete the information required by OSEP.  Registering a student for the database is separate from requesting consultation from GSAP .  If you want a classroom or home visit from us, go to our website http://gsap.coe.uga.edu/services/technical-assistance and complete a TA Request form.

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* 1. Student's First Name

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* 2. Middle Name

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* 3. Student's Last Name

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* 4. GTID #

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* 5. Date of Birth  (MM/DD/YYYY)

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* 6. Gender

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* 7. Race

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* 8. Comment about student enrollment or placement

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* 9. School District

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* 10. School  ( if homebound, write home)

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* 11. Student Address

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* 12. Person who will update registry information (administrator, teacher, or related service provider). 
Access to information about the student's vision, hearing, communication, eligibility and placement are needed.
This person will receive an email asking them to log into our system and update the remainder of the student's registry.

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* 13. Classroom teacher (if the same as above, just type same in each box)

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