* 1. I am answering this survey as a representative of _________________________ (Region Center#____ , District/Charter, etc.)

* 2. My Region/District was affected by Hurricane Harvey

* 3. My Region/District Assistive Technology tools were affected by Hurricane Harvey

* 4. Specifically, Assistive Technology on these campuses was negatively impacted by Hurricane Harvey (please type out the full name of each campus)

* 5. Students in my Region/District will not receive FAPE as a result of damaged/lost Assistive Technology Tools

* 6. My Region/District has a plan to replace damaged/lost Assistive Technology Tools

* 7. I need help from Region 4 or TATN to support the provision of AT devices damaged/lost as a result of Hurricane Harvey

* 8. Specifically, Region 4 or TATN could help by __________________________

* 9. Any additional comments or concerns?

* 10. Contact Information- Name, email, phone (optional)

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