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* 1. A little about you...

Name

City/Town

State

Zip/Postal Code

Email Address

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* 2. I am a...(choose as many as needed)

Parent

Professional

Other

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* 3. If you chose "Parent" above, what are your child/children's ages?

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* 4. If you chose "Parent" above, what are your child/children’s disabilities?

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* 5. What is your race/ethnicity? (Optional)

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* 6. Which county do you live in?