Communication Board Customization
Please fill out the request form to indicate the location on the board of the symbols you would like to replace (symbol- row #, column #) and include a description of the new symbols or photos you would like to include.  You may include your own photographs with your request. A staff member from Down Syndrome Connection of the Bay Area will respond to your request and complete the customization.
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone number  *
Today's Date *
MM
/
DD
/
YYYY
Which communication board would you like customized?  Please write in title below. *
Required
What gender identity would you prefer represented on the board?  You may opt not to have one.
What race would you prefer represented on the board?  You may opt not to have one.
What age range (baby, young child, school aged, teen, adult, elderly) would you prefer represented on the board?  You may opt not to have one.
Please describe the customization needed. State what pictures, words, icons you would like and how you want them labeled.  Please state which column and row you would like them places. *
Please list and describe photographs/pictures/icons you would like added here and email them to AAC@dscba.org
Thank you for your request.  An AAC Specialist will respond to you in 3-5 business days.  Include any questions or comments below.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms