Connecting Families - Join the Network
Dear Listen and Talk Families (Current and Alumni),

Over the years, we often have families inquire about how they can connect with other families who have experienced some of the same life experiences. These families are looking for a way to meet and learn from others who may understand their needs and the opportunity to learn from their perspective about the journey ahead of them.

We are reaching out to find current and alumni families who may be interested in participating in our network and sharing about their family’s experiences. We are gathering family information to help us match families according to their similar characteristics or interests. Some of the information we plan to collect includes child’s hearing levels, home language(s), type of technology used, where families live, etc.

Your answers will not be shared with others without your permission. Each time a request to connect is made, we will contact you for permission to connect you with another family.

Thank you again for your interest in joining the Connecting Families Network!

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Email *
Child's First Name *
Child's Last Name *
Date of birth *
MM
/
DD
/
YYYY
Parent/Caregiver Name(s) *
Phone number(s)
Email address(es)
Best way to contact you: *
Required
How would you like to connect with another family? *
Required
Cause of hearing loss (if known)
Age of onset of hearing loss *
Hearing level RIGHT *
Child's age when amplified RIGHT
Technology RIGHT *
Brand of technology RIGHT *
Hearing level LEFT *
Child's age when amplified LEFT
Technology LEFT *
Brand of technology LEFT *
Additional needs
City where you live *
School district
County *
Languages Spoken at Home *
Which Listen and Talk services did your family access *
Required
Who were your direct Listen and Talk providers? (lead teacher, therapist, and/or B-3 provider)
Hospital/Clinic for audiology services *
Did/does your child attend daycare? *
Activities your child enjoys (e.g. skiing, swimming, football, music, instruments, etc.)
OPTIONAL: Other important information (e.g., religion, country, additional family members with hearing loss, etc.)
Additional comments
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