Family Learning ASL Program
12 sessions (30 minutes each)
Deadline: January 18, 2010
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Name of Parent/Guardian:
*
First
Last
Email:
*
Street Address:
*
Unit No.
City, State, Zip:
*
Telephone:
Child's Name:
*
Child's Age:
*
Deaf
Hard of Hearing
Other
Language you are currently using
at home with your child:
*
English
Spanish
Other
Product you currently use
for video relay calls:
*
PC
Mac
MVP
VP-100
VP-200
I'm requesting one of these products
I don't have one
Video Phone # / IP Address:
Services you are
interested in:
Hands On VRS
Spanish VRS
Community Sign Language Servies
Please include any questions or comments you may have:
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