Community Health and Literacy Program: Introduction Application
Vision
Bilingual literacy begins at home.

Mission
Families in Michigan with at least one family member who is Deaf, DeafBlind, or Hard of Hearing, including those who use listening assistance-technology devices and , will communicate and participate in literacy activities together through American Sign Language and English at home with the guidance of trained mentors.

About the program
The Community Health Literacy is a home-based program that runs during the academic year, where trained mentors go to their assigned families’ home once a week for one hour/two hours. The research and evidence-based curriculum will be used in this program. This program provides educational access to:

Reading and writing literacy
Math literacy
Language acquisition
Incidental learning environments
American Sign Language
Deaf Culture
Need-based resources
Community events

Please contact Community Health and Literacy Program Director, Maria Klein at chlmeklein@gmail.com and/or Program Director.  if you have any questions or comments. 
Sign in to Google to save your progress. Learn more
Email *
Phone Number *
Family Name *
Your First Name and Last Name *
Your relationship to the Deaf, DeafBlind, and Hard of Hearing child(ren)? *
Required
Are you (parent/guardian/caregiver): *
Required
What county do you live in? *
What city do you live in? *
How many family members will be joining the CHLP sessions (parents, children, live-in relatives)? *
Required
How many children are Deaf, DeafBlind, and Hard of Hearing? *
Required
Is your child #1 Deaf, DeafBlind, or Hard of Hearing? *
Required
What is your child #1 age?  *
Is your child #2 Deaf, DeafBlind, or Hard of Hearing?
What is your child #2 age?
Does your Deaf, DeafBlind, and Hard of Hearing child(ren) wear listening technology devices? *
Required
How did you hear about us?
Any comments or questions?
Thank you for filling this out! You will be contacted shortly. If you have any questions, please reach out to Maria Klein at chlmeklein@gmail.com. 
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms