WCBVI Outreach Virtual Assistance Request Form
If you would like any assistance in completing this form or have questions, please contact:
WCBVI Outreach Office Operations Associate
Phone: (608) 758-6148
Virtual Assistance Request Process Flowchart
Please note that after 3 follow up attempts within two weeks, we can consider the OSR closed and the requester needs to fill out another form.
(Parent/Guardian, Vision Professional, Education Professional, WSBVI Professional, Birth to Three Professional, Agency, Other)
Please list the school district, agency or county for which you are associated.
Name of Teacher of the Visually Impaired (TVI) and/or Orientation & Mobility Specialist (O&M) and Special Education Director.
Birth to Three Training
Three to Six Consultation
School Age Consultation
Orientation & Mobility (O&M) Consultation
Assistive Technology Consultation
Virtual Mini Low Vision Clinic
Parent Liaison (0 through 12)
Parent Liaison (13 through 21)
Virtual Event Support (WCBVI Outreach will do our best to support virtual events based on current staffing)
Professional Development Needs
Give us a short summary of your needs.
Please keep your answer to 1-3 sentences only.
Opt in statement: by completing the student name section of this form, you state that you understand that student name is Personally Identifiable Information (PII). If you do not wish to share your students PII on this form, please leave a message with your name, the date of your request, and the student name for Outreach at (608) 758-6148.
How would you prefer to be contacted?
Zoom Meeting (a link will be sent to your email)
Best time to contact you:
Please list the contact information for your preferred method of contact (phone or email address).
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This form was created inside of Wisconsin Center for the Blind and Visually Impaired.