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SSP Provider Registration
Please note that you will be responsible for all expenses (meals, travel, and lodging) associated with attending this
free
training opportunity.
*
1.
Name (First & Last)
(Required.)
*
2.
Email Address
(Required.)
*
3.
Phone Number
(Required.)
*
4.
Where will you be providing SSP services? (City or county)
(Required.)
*
5.
What is your occupation/job title?
(Required.)
*
6.
How would you rate your knowledge of ASL?
(Required.)
No experience
Basic understanding
Conversational understanding
Professional understanding
*
7.
Will you be able to attend the in-person SSP training February 2nd & 3rd, 2026 at the McDowell Center in Louisville, KY?
(Required.)
Yes
No (please note: you will not receive a certificate for full completion of the training)
*
8.
Which option best describe your experience working with individuals who are DeafBlind?
(Required.)
I have no or minimal experience working with individuals who are DeafBlind
I have worked occasionally with individuals who are DeafBlind
I work frequently with individuals who are DeafBlind, but I am not at this time
I work with individuals who are DeafBlind on a daily basis
*
9.
Do you require CEUs for attending?
(Required.)
Yes
No
*
10.
Do you require accommodations to participate in these training? (Virtual and/or in-person!)
(Required.)