Registration Form

On-Demand Learn About Early Childhood Special Education

01/09/2023 - 01/01/2029

Admission

Free

On Demand Learning About Early Childhood Special Education

On completion of this form you will have access to the the On-Demand training: Learning About Early Childhood Special Education

Number of Attendees: First Name: Last Name: Email: Phone: Address: City: County: (eg: Crook, Deschutes, Grant, Harney, Jefferson, Klamath, Lake, Wheeler) Zip: - State: Company/Organization: Primary Role: Secondary Role:

School District Information

Which school district does your child with a disability attend?

Leave this blank if the district does not appear below.

Crook County: Deschutes County: Grant County: Harney County: Jefferson County: Klamath County: Lake County: Wheeler County:

Demographic Information

While the demographic information that you provide is voluntary, the funding sources that support CODSN's work, request data periodically.

Primary Language: Secondary Language: Ethnic/Racial Identity:

Information about your child/children with a disability

Please share more information so that we are able to help you in the future.

I or my family receive/experience the following: 1st Child's Name: 1st Child's Year of Birth: 1st Child's Ethnic/Racial Identity: 1st Child's Primary Disability Diagnosis: 1st Child's Primary School Eligibility (IDEA): 2nd Child's Name: 2nd Child's Year of Birth: 2nd Child's Ethnic/Racial Identity: 2nd Child's Primary Disability Diagnosis: 2nd Child's Primary School Eligibility (IDEA):

required fields