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Questionnaire for Parents with Children who are Deaf or Hard of Hearing in Michigan.
This questionnaire is to help Michigan Hands & Voices provide services. The goal is to share information and a full variety of perspectives with families to help parents raise their children who are Deaf or Hard of Hearing.
Email address *
Name: *
Your answer
Address: *
Your answer
Phone #:
Your answer
How old is your child? *
At what clinic was your child's hearing loss identified? *
Your answer
What level of hearing loss does your child have? *
If select other, please describe.
Required
Does your child have conditions in addition to being deaf or hard of hearing? *
Are you familiar with hearing assistive technology? *
Hearing assistive technology includes devices which can help in various listening situations such as hearing aid, cochlear implant, BAHA, FM Systems, etc.
Do you have relatives who had a hearing loss from early in life? *
What communication modes and/or languages would you like to learn more about? *
One of the goals of MHV is to help parents increase their child's language proficiency.
Required
Who would your family like to meet to learn more about supporting your Deaf or Hard of Hearing child? *
Select all that apply
Required
What would you like to discuss with an Adult Role Model who is Deaf or Hard of Hearing? (check all that apply) *
Required
Our goal is to provide Deaf/Hard of Hearing Role Models for families by the end of 2018. What questions do you have for Michigan Hands & Voices?
Please list any questions for MHV regarding connections with Role Models:
Your answer
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