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* 1. In what county do you currently teach?

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* 2. Do you hold any of the following endorsements/certifications?  Please mark all that apply.

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* 3. What grades do you currently teach? Please mark all that apply.

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* 4. Do you currently teach in a: (Please mark all that apply)

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* 5. How many students do you currently teach who would be considered blind or visually impaired?   For the purpose of this survey, a person with a visual impairment will be defined as; any student who has a condition that leads to a reduction in visual functioning which has any impact on their academic performance, independent living or ability to travel safely in their environment without assistance.

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* 6. Have you ever heard of any of the following specialists? Please mark all that apply.

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* 7. Have you ever referred a student who is blind or visually impaired to any of the following specialist for services or assessment?

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* 8. When you have a student in need of specialized services from a professional outside your classroom, where do you typically look for information about that service/professional in order to make the referral?  Please mark all that apply.

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* 9. Have you ever heard of Montana Independent Living Project?

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* 10. Would you be interested in receiving more information regarding vision related services for students in your area?

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