I am interested in attending the 2019 Illinois Summer Institute on Touch Signals! I understand that completing this form indicates my interest and provides Project Reach with needed information, but is not a confirmed registration.

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* 1. First Name:

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* 2. Last Name:

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* 3. What agency do you work for?

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* 4. What is your role with children/youth who are DeafBlind?

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* 5. Do you currently work with a child/youth on the Project Reach child count?

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* 6. If so, what is that child’s birthdate?

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* 7. What is your summer email address that you check frequently?

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* 8. What is a summer phone number?  Cell or landline?

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* 9. When do you leave for summer break?

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* 10. When do you return to school?

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* 11. Could you commit to attend the entire Institute (August 14 – 16)?

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* 12. Is there anything else you want us to know?

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* 13. Would you like to be on the Project Reach mail list?

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