Request edit access
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.
How old is your child?
Less than 1 year old
1 to 3 years old
4 to 6 years old
6 to 8 years old
8 to 12 years old
12 to 18 years old
At what clinic was your child's hearing loss identified?
What level of hearing loss does your child have?
If select other, please describe.
Mild 21db - 40db
Moderate 41db - 70db
Severe 71db - 95db
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.
No, I need more information about devices.
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.
American Sign Language
Signed Exact English
Listening and Spoken Language
I don't know. I need to learn more about all the options.
Who would your family like to meet to learn more about supporting your Deaf or Hard of Hearing child?
Select all that apply
Parent Guide: Another Parent of a Child who is Deaf or Hard of Hearing.
We already have a Parent Guide, and now would like to meet with an Adult Role Model.
Culturally Deaf Adult Role Model who primarily uses American Sign Language.
Deaf/Blind Role Model
Adult Role Model who primarily uses Listening and Spoken Language.
Adult Role Model who uses Cued Speech.
What would you like to discuss with an Adult Role Model who is Deaf or Hard of Hearing? (check all that apply)
Comfort and acceptance with my child's deafness or hearing loss.
Learn about different ways my child can communicate.
What they liked and disliked about how their families and communities supported them growing up.
A vision of what the future might be like for my child.
Learn about different assistive hearing technologies.
Pros and cons of various educational/school placement options.
How to help my child grow up with a positive self-identity and with self-reliance.
Overcoming myths about deafness and hearing loss.
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:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service