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Email address (UW email if possible)
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Your answer
First Name
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Last name
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Affiliation with UW (check all that apply)
*
Undergraduate student
Graduate or professional student
Recent UW alumni
UW staff
UW faculty
Community member not affiliated with UW
Local teacher (Preschool or K-12)
Local clinician (physical therapist, occupational therapist, speech therapist, etc.)
Needs expert (an individual with a disability, or an individual with a child or other loved one with a disability)
Other:
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How did you hear about us? (check all that apply)
Word of mouth
Facebook
Saw a flier
Someone talked about HuskyADAPT in one of my classes
Attended a previous HuskyADAPT event
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Other:
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