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Asian American Support Group Registration Form
Support Group for AANHPI (Asian American Native Hawaiian Pacific Islander) Parents of Children with Disabilities
Monthly on Tuesdays
May 6th
June 10th
July 8th
August 12th
September 9th
October 7th
November 4th
December 9th
6:00-7:30pm
Online via Zoom
Contact me at (303) 632-6840 or
coco@weshowandtell.org
for questions
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* Indicates required question
Email
*
Your email
First & Last Name
*
Your answer
Phone Number
*
Your answer
Please indicate whether you are one of the following:
*
Parent/ Guardian
Caregiver
Advocate/ Professional
Other:
Required
Please select your child's disabilities
*
ADD/ ADHD
Autism Spectrum Disorder
Deaf-Blindness
Developmental Delay (Early Childhood)
Emotional Disturbance
Gifted
Hearing Impairment (Including Deafness)
Intellectual Disability
Multiple Disabilities
Orthopedic Impairment (Physical)
Other Health Impairment
Specific Learning Disability
Speech Language Impairment
Traumatic Brain Injury
Visual Impairment (including blindness)
Suspected/Undiagnosed
No IDEA Disability
Other:
Required
Please describe your race/ethnicity:
*
Asian Indian
Bangladeshi
Bhutanese
Burmese
Cambodian
Chinese
Fijian
Filipinx
Guamanian
Hmong
Indonesian
Japanese
Korean
Lao
Malaysian
Mongolian
Native Hawaiian
Nepali/Nepalese
Pakistani
Palauan
Saipanese
Samoan
Sri Lankan
Taiwanese
Thai
Tongan
Vietnamese
Alaska Native
Black/ African American
Native American
Hispanic/Latino
White/Caucasian
Other:
Required
What is your child/children's age(s)?
*
Your answer
What are you hoping to get out of this support group?
Your answer
Do you require any accommodations? If so, please specify.
Your answer
How did you hear about Show and Tell?
Your answer
Send me a copy of my responses.
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